Provider Demographics
NPI:1699333484
Name:WAIALAE, KAYLA LEILANI
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LEILANI
Last Name:WAIALAE
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 1:465 LODGE DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1967
Mailing Address - Country:US
Mailing Address - Phone:304-639-5185
Mailing Address - Fax:
Practice Address - Street 1:1 HALLORAN DRIVE
Practice Address - Street 2:
Practice Address - City:ST. CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-296-5743
Practice Address - Fax:740-296-5952
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician