Provider Demographics
NPI:1134859754
Name:VILBIG, KADE (BA)
Entity type:Individual
Prefix:
First Name:KADE
Middle Name:
Last Name:VILBIG
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MRS
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:VILBIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:809 S 4TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6619
Mailing Address - Country:US
Mailing Address - Phone:208-243-5173
Mailing Address - Fax:
Practice Address - Street 1:255 E ST APT 104
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3526
Practice Address - Country:US
Practice Address - Phone:208-243-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist