Provider Demographics
NPI:1194569749
Name:SHADISH, KAYTLYN PAIGE (RBT)
Entity type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:PAIGE
Last Name:SHADISH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KAYTLYN
Other - Middle Name:PAIGE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:504 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2044
Mailing Address - Country:US
Mailing Address - Phone:724-271-8416
Mailing Address - Fax:
Practice Address - Street 1:2500 BROOKTREE RD STE 101
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9278
Practice Address - Country:US
Practice Address - Phone:412-301-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-222726106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician