Provider Demographics
NPI:1851005342
Name:LUPARELL, KAILEY RYANNE
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:RYANNE
Last Name:LUPARELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 KENT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5046
Mailing Address - Country:US
Mailing Address - Phone:217-491-8403
Mailing Address - Fax:
Practice Address - Street 1:22 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1605
Practice Address - Country:US
Practice Address - Phone:708-912-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-22-247708106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician