Provider Demographics
NPI:1457920357
Name:DELATRE, KAYLA JOANIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JOANIE ELIZABETH
Last Name:DELATRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2519
Mailing Address - Country:US
Mailing Address - Phone:312-605-2009
Mailing Address - Fax:
Practice Address - Street 1:3050 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2519
Practice Address - Country:US
Practice Address - Phone:312-605-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician