Provider Demographics
NPI:1427698471
Name:SMITH, KAYLIE TERESA KATHLEEN (BA)
Entity type:Individual
Prefix:
First Name:KAYLIE TERESA
Middle Name:KATHLEEN
Last Name:SMITH
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:KAYLIE TERESA
Other - Middle Name:KATHLEEN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14630 MEADOWS CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-4668
Mailing Address - Country:US
Mailing Address - Phone:425-445-6621
Mailing Address - Fax:
Practice Address - Street 1:4412 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-3500
Practice Address - Country:US
Practice Address - Phone:253-345-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KC6832OtherCARD