Basic Information
| Provider Information | |||||||||
| NPI: | 1033716360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | KAYLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15A E DUNDEE QUARTER DR UNIT 307 | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600741670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474528264 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1725 S NAPERVILLE RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601895855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307938404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2020 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | IL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.