Provider Demographics
NPI:1689469231
Name:BANCROFT, KYLA MICHELLE
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:MICHELLE
Last Name:BANCROFT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:MICHELLE
Other - Last Name:HAFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 N PINAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-3336
Mailing Address - Country:US
Mailing Address - Phone:520-494-2242
Mailing Address - Fax:623-265-6163
Practice Address - Street 1:1201 N PINAL AVE STE A
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-3336
Practice Address - Country:US
Practice Address - Phone:520-494-2242
Practice Address - Fax:623-265-6163
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHADE16073237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist