Provider Demographics
NPI:1316684731
Name:PRICE-WALLIN, KYLA JEWEL (RBT)
Entity type:Individual
Prefix:MISS
First Name:KYLA
Middle Name:JEWEL
Last Name:PRICE-WALLIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 S 138TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2913
Mailing Address - Country:US
Mailing Address - Phone:402-895-4000
Mailing Address - Fax:
Practice Address - Street 1:5321 S 138TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2913
Practice Address - Country:US
Practice Address - Phone:402-895-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-199873106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician