Provider Demographics
NPI:1285520239
Name:SQUIRES, KYLEE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6828 LACKMAN RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9595
Mailing Address - Country:US
Mailing Address - Phone:913-608-7005
Mailing Address - Fax:
Practice Address - Street 1:6828 LACKMAN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9595
Practice Address - Country:US
Practice Address - Phone:913-608-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician