Most Relevant Information
Provider Data
| NPI Number: | 1003403494 |
| Provider Name: | KAYLA BROOKE FANUM |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/31/2020 |
| Last Updated: | 12/31/2020 |
Provider Practice Location
690 CLEVELAND AVE S STE 100
SAINT PAUL
MN
551161319
Practice Location Phone/Fax
| Phone: | 6514938412 |
| Fax: | 6519270404 |
Provider Mailing Location
690 CLEVELAND AVE S STE 100
SAINT PAUL
MN
551161319
Provider Mailing Phone/Fax
| Phone: | 6514938412 |
| Fax: | 6519270404 |