Provider Demographics
NPI:1922445287
Name:ELIAS, KAYLIE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 BLUEBIRD TER
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1101
Mailing Address - Country:US
Mailing Address - Phone:216-394-9799
Mailing Address - Fax:
Practice Address - Street 1:9374 OLIVE BLVD
Practice Address - Street 2:101
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3253
Practice Address - Country:US
Practice Address - Phone:314-932-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst