Provider Demographics
NPI:1306697412
Name:ANDERSON, KAYLEE ANNE
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20367 BENSON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-7646
Mailing Address - Country:US
Mailing Address - Phone:360-913-8664
Mailing Address - Fax:
Practice Address - Street 1:300 N ARGONNE RD STE 204
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2839
Practice Address - Country:US
Practice Address - Phone:509-991-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician