Provider Demographics
NPI:1235698150
Name:RICHARDS, KAYLEE JO (BS LADC)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:JO
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:BS LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 EGRET CT NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4683
Mailing Address - Country:US
Mailing Address - Phone:320-460-0286
Mailing Address - Fax:
Practice Address - Street 1:909 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1813
Practice Address - Country:US
Practice Address - Phone:320-763-0124
Practice Address - Fax:320-763-0126
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305366101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)