Provider Demographics
NPI:1699524587
Name:WINCHELL, KAYLA
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:
Last Name:WINCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BRISSETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 S WARNER ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-5042
Mailing Address - Country:US
Mailing Address - Phone:989-482-1130
Mailing Address - Fax:
Practice Address - Street 1:806 S WARNER ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-5042
Practice Address - Country:US
Practice Address - Phone:989-482-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician