Provider Demographics
NPI:1447005665
Name:HERITAGE, KAYLA MARIE (SSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:HERITAGE
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 BANBURY DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9487
Mailing Address - Country:US
Mailing Address - Phone:801-931-9989
Mailing Address - Fax:
Practice Address - Street 1:880 HERITAGE PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5674
Practice Address - Country:US
Practice Address - Phone:801-931-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor