Provider Demographics
NPI:1669121372
Name:MCCUDDIN, KAYLA (MSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MCCUDDIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CAMBRIDGE CV
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:ND
Mailing Address - Zip Code:58785-5009
Mailing Address - Country:US
Mailing Address - Phone:605-212-7921
Mailing Address - Fax:
Practice Address - Street 1:3300 S BROADWAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7643
Practice Address - Country:US
Practice Address - Phone:701-852-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker