Provider Demographics
NPI:1821628660
Name:KRECH, KAYLEIGH
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:KRECH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1541 RACINE AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT CROIX BEACH
Mailing Address - State:MN
Mailing Address - Zip Code:55043-9406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2925 DEAN PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-7700
Practice Address - Country:US
Practice Address - Phone:612-925-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1-19-400025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty