Provider Demographics
NPI:1063245546
Name:HUI, KAITLYN ANNE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANNE
Last Name:HUI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 E BRADFORD PKWY STE J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6884
Mailing Address - Country:US
Mailing Address - Phone:417-324-7777
Mailing Address - Fax:
Practice Address - Street 1:1426 E BRADFORD PKWY STE J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6884
Practice Address - Country:US
Practice Address - Phone:417-324-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MO2024033805103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician