Provider Demographics
NPI:1700557725
Name:KANNING, KAYLEE SUE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:SUE
Last Name:KANNING
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 1:2309 NINA CLARE RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2141
Mailing Address - Country:US
Mailing Address - Phone:406-544-6547
Mailing Address - Fax:
Practice Address - Street 1:1235 WICKS LN W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3584
Practice Address - Country:US
Practice Address - Phone:406-544-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-49961101YA0400X
MTBBH-PCLC-LIC-49518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)