Provider Demographics
NPI:1396130035
Name:OMAN, KAILA (BCBA)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:OMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:12291 FORT CUSTER DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-8797
Mailing Address - Country:US
Mailing Address - Phone:269-615-8674
Mailing Address - Fax:
Practice Address - Street 1:9880 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-8641
Practice Address - Country:US
Practice Address - Phone:269-665-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-15-18190103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst