Provider Demographics
NPI:1467285171
Name:STRUCHEN, KAYLEIGH MICHELLE (EDS)
Entity type:Individual
Prefix:MRS
First Name:KAYLEIGH
Middle Name:MICHELLE
Last Name:STRUCHEN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1383
Mailing Address - Country:US
Mailing Address - Phone:260-446-0100
Mailing Address - Fax:
Practice Address - Street 1:800 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1383
Practice Address - Country:US
Practice Address - Phone:260-446-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10106736103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool