Provider Demographics
NPI:1831941863
Name:HAWKS, KYLIE (RBT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:HAWKS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60474-0125
Mailing Address - Country:US
Mailing Address - Phone:815-374-0642
Mailing Address - Fax:
Practice Address - Street 1:475 BROWN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2325
Practice Address - Country:US
Practice Address - Phone:815-763-1406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-24-331793106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician