Provider Demographics
NPI:1891673620
Name:BECKROW, KAILA (EDS)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:BECKROW
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CLOUGH ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2901
Mailing Address - Country:US
Mailing Address - Phone:410-354-0400
Mailing Address - Fax:
Practice Address - Street 1:137 CLOUGH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2901
Practice Address - Country:US
Practice Address - Phone:410-354-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROH3385667103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool