Provider Demographics
NPI:1558851006
Name:MALMBERG, KYLIE LOUISE (MS)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:LOUISE
Last Name:MALMBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:LOUISE
Other - Last Name:MALMBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3100 NE 83RD ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 NE 83RD ST STE 1001
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-4460
Practice Address - Country:US
Practice Address - Phone:816-468-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MO2021040954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician