Provider Demographics
NPI:1811430044
Name:EDWARDS, KAYLA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARIE
Other - Last Name:ROMANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4330 GOLF TER STE 218
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4688
Mailing Address - Country:US
Mailing Address - Phone:608-709-9141
Mailing Address - Fax:
Practice Address - Street 1:4330 GOLF TER STE 218
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4688
Practice Address - Country:US
Practice Address - Phone:608-709-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-20
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI98-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst