Provider Demographics
NPI:1851054464
Name:METREGER, KAYLA RAE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:METREGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANE
Other - Middle Name:ELLIOT
Other - Last Name:METREGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4031 W DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8377
Mailing Address - Country:US
Mailing Address - Phone:815-344-1230
Mailing Address - Fax:
Practice Address - Street 1:4031 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8377
Practice Address - Country:US
Practice Address - Phone:815-344-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker