Provider Demographics
NPI:1578309084
Name:HELLER, KAELYN (RBT)
Entity type:Individual
Prefix:
First Name:KAELYN
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-3358
Mailing Address - Country:US
Mailing Address - Phone:620-960-3464
Mailing Address - Fax:
Practice Address - Street 1:971 E WICHITA AVE
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2444
Practice Address - Country:US
Practice Address - Phone:785-377-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician