Provider Demographics
NPI:1487321451
Name:PATCH, KAELYN SIERRA
Entity type:Individual
Prefix:
First Name:KAELYN
Middle Name:SIERRA
Last Name:PATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6644
Mailing Address - Country:US
Mailing Address - Phone:603-686-1646
Mailing Address - Fax:
Practice Address - Street 1:9 CEDARWOOD DR UNIT 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6801
Practice Address - Country:US
Practice Address - Phone:603-506-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician