Provider Demographics
NPI:1386987782
Name:CAMPBELL, KYLEE A (MED, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MED, BCBA, LABA
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:A
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1573 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3740
Mailing Address - Country:US
Mailing Address - Phone:508-617-8396
Mailing Address - Fax:508-401-2696
Practice Address - Street 1:1573 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771
Practice Address - Country:US
Practice Address - Phone:508-617-8396
Practice Address - Fax:508-401-2696
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11520724103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst