Provider Demographics
NPI:1780130526
Name:ROSENBERGER, KAYLA (MED, BCBA-LBA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:MED, BCBA-LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N. DOBSON RD
Mailing Address - Street 2:STE F-2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8594
Mailing Address - Country:US
Mailing Address - Phone:480-722-1300
Mailing Address - Fax:480-422-3824
Practice Address - Street 1:3200 N. DOBSON RD
Practice Address - Street 2:STE F-1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-722-1300
Practice Address - Fax:480-422-3824
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA156103K00000X
AZBEH-000156103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ272532Medicaid