Provider Demographics
NPI:1912773581
Name:KALEIDOSCOPE CONNECTIONS, PLLC
Entity Type:Organization
Organization Name:KALEIDOSCOPE CONNECTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:949-573-3165
Mailing Address - Street 1:11301 SE 10TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-6119
Mailing Address - Country:US
Mailing Address - Phone:949-573-3165
Mailing Address - Fax:
Practice Address - Street 1:11301 SE 10TH ST APT 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-6119
Practice Address - Country:US
Practice Address - Phone:949-573-3165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health