Individual
MR. KYLE STUART JERDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BACHELOR
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225X00000X
Occupational Therapist
Primary
11709
MA
Other
Enumeration date
07/15/2012
Last updated
12/08/2015
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