Provider Demographics
NPI:1174165161
Name:HILL, KAYLYN
Entity type:Individual
Prefix:
First Name:KAYLYN
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 GRAND HARMONY BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3743
Mailing Address - Country:US
Mailing Address - Phone:307-220-5475
Mailing Address - Fax:
Practice Address - Street 1:3120 OLD FAITHFUL RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5865
Practice Address - Country:US
Practice Address - Phone:910-849-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician