Provider Demographics
NPI:1922460443
Name:SEVERSON, KAYLA FRANCES (MA, SAC)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:FRANCES
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:MA, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 STATE ROAD 136 STE 1
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9252
Mailing Address - Country:US
Mailing Address - Phone:084-779-8586
Mailing Address - Fax:877-560-0578
Practice Address - Street 1:840 STATE ROAD 136 STE 1
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9252
Practice Address - Country:US
Practice Address - Phone:608-477-9858
Practice Address - Fax:877-560-0578
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16324-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100079039Medicaid