Provider Demographics
NPI:1396469292
Name:SLOAN, KAYLEIGH RANEE (MA, LAC, LPCC)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:RANEE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MA, LAC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 KILLDEER CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2167
Mailing Address - Country:US
Mailing Address - Phone:719-248-5844
Mailing Address - Fax:
Practice Address - Street 1:3930 RIDGE DR STE D
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1766
Practice Address - Country:US
Practice Address - Phone:719-828-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD0002442101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherNOT AVAILABLE