Individual
KYLEE A VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25212 US HIGHWAY 20, FAYETTE, OH 43521-9511
(419) 237-3103
(419) 237-4044
Mailing address
25212 US HIGHWAY 20, FAYETTE, OH 43521-9511
(419) 237-3103
(419) 237-4044
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDCA.140402
LICENSE
OH
Enumeration date
12/07/2017
Last updated
12/07/2017
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