Provider Demographics
NPI:1417590340
Name:ROBLES, KAYLEIGH SIMONE
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:SIMONE
Last Name:ROBLES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9543 S 700 E FL 2
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3495
Mailing Address - Country:US
Mailing Address - Phone:801-251-6306
Mailing Address - Fax:
Practice Address - Street 1:9543 S 700 E FL 2
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3495
Practice Address - Country:US
Practice Address - Phone:385-557-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)