Provider Demographics
NPI:1063096840
Name:PEELLE, KAITLYN BAILEY
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:BAILEY
Last Name:PEELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 E PACIFIC COAST HWY APT 239
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4434
Mailing Address - Country:US
Mailing Address - Phone:925-200-4868
Mailing Address - Fax:
Practice Address - Street 1:4844 RESEARCH DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-9202
Practice Address - Country:US
Practice Address - Phone:760-815-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician