NPI 1003403494

Kayla Brooke Fanum

Practitioner Behavior Technician Saint Paul, MN

Practice location

Address: 690 Cleveland Ave S STE 100, Saint Paul, MN 55116-1319
Phone: (651) 493-8412
Fax: (651) 927-0404

Registered specialties

Behavior Technician Primary

Behavioral Health & Social Service Providers Taxonomy 106S00000X

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Registry record

NPI: 1003403494
Entity type: Individual
Sex (as registered): Female
NPI issued: 31 Dec 2020
Record last updated: 31 Dec 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.