Provider Demographics
NPI:1063972453
Name:WILLOUGHBY, KAYLA ELIZABETH (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ELIZABETH
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2536
Mailing Address - Country:US
Mailing Address - Phone:812-944-1550
Mailing Address - Fax:
Practice Address - Street 1:3902 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-3576
Practice Address - Country:US
Practice Address - Phone:812-207-6962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008224A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker