Provider Demographics
NPI:1538748447
Name:CAYABYAB, KATE JENNICA LADION (QBA)
Entity type:Individual
Prefix:
First Name:KATE JENNICA
Middle Name:LADION
Last Name:CAYABYAB
Suffix:
Gender:F
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8178 BRIGANTINE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4404
Mailing Address - Country:US
Mailing Address - Phone:719-354-5918
Mailing Address - Fax:
Practice Address - Street 1:1555 VAPOR TRL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2722
Practice Address - Country:US
Practice Address - Phone:719-451-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-21-152834106S00000X
18037103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000145075Medicaid