Provider Demographics
NPI:1457953242
Name:ORTIZ, KAYLA CARLEEN I
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:CARLEEN
Last Name:ORTIZ
Suffix:I
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 1:1802 S 825 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5475
Mailing Address - Country:US
Mailing Address - Phone:309-750-3617
Mailing Address - Fax:
Practice Address - Street 1:1802 S 825 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5475
Practice Address - Country:US
Practice Address - Phone:309-750-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL063250397738103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst