Provider Demographics
NPI:1194343558
Name:GEE, KAYLA CLARA (AA-T)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:CLARA
Last Name:GEE
Suffix:
Gender:F
Credentials:AA-T
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:CLARA
Other - Last Name:GEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AA-T
Mailing Address - Street 1:7109 DANNY DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-5320
Mailing Address - Country:US
Mailing Address - Phone:209-957-7777
Mailing Address - Fax:209-473-3344
Practice Address - Street 1:7109 DANNY DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5320
Practice Address - Country:US
Practice Address - Phone:209-957-7777
Practice Address - Fax:209-473-3344
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA12-12345106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician