Provider Demographics
NPI:1922483635
Name:RAMER, KILEY (BCBA)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:RAMER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KILEY
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:6910 N MAIN ST BLDG 13 C BOX 51
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-2635
Mailing Address - Country:US
Mailing Address - Phone:574-217-1624
Mailing Address - Fax:574-889-9524
Practice Address - Street 1:6910 N MAIN ST BLDG 13C51
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-217-1624
Practice Address - Fax:574-889-9524
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-15-19305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1-15-19305OtherBCBA