Provider Demographics
NPI:1598657868
Name:VALLEJO, KIARRA MARIE
Entity type:Individual
Prefix:
First Name:KIARRA
Middle Name:MARIE
Last Name:VALLEJO
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 1:2130 GRAFTON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-2309
Mailing Address - Country:US
Mailing Address - Phone:719-299-8944
Mailing Address - Fax:
Practice Address - Street 1:2130 GRAFTON DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2309
Practice Address - Country:US
Practice Address - Phone:719-299-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician