Provider Demographics
NPI:1629559620
Name:CHANG, KAYLA-JO
Entity type:Individual
Prefix:
First Name:KAYLA-JO
Middle Name:
Last Name:CHANG
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 1:1280 LARPENTEUR AVE W APT 213
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6344
Mailing Address - Country:US
Mailing Address - Phone:808-683-6068
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 187
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2814
Practice Address - Country:US
Practice Address - Phone:808-683-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI680103K00000X
MN049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst