Provider Demographics
NPI:1982258034
Name:REGALADO, KIERRA E (IS)
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:E
Last Name:REGALADO
Suffix:
Gender:F
Credentials:IS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12427 S SUNRISE MIST LOOP
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5463
Mailing Address - Country:US
Mailing Address - Phone:208-697-3845
Mailing Address - Fax:
Practice Address - Street 1:12427 S SUNRISE MIST LOOP
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5463
Practice Address - Country:US
Practice Address - Phone:208-697-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst