Provider Demographics
NPI:1053150094
Name:BISCH, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40182 W 379TH ST
Mailing Address - Street 2:
Mailing Address - City:LANE
Mailing Address - State:KS
Mailing Address - Zip Code:66042-4168
Mailing Address - Country:US
Mailing Address - Phone:417-415-9814
Mailing Address - Fax:
Practice Address - Street 1:29875 W 339TH ST
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-4159
Practice Address - Country:US
Practice Address - Phone:417-415-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician