Provider Demographics
NPI:1881346716
Name:HODECKER, KAYLA NICOLE (MS)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:HODECKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2965
Mailing Address - Country:US
Mailing Address - Phone:717-304-2631
Mailing Address - Fax:
Practice Address - Street 1:746 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5236
Practice Address - Country:US
Practice Address - Phone:717-304-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health