Provider Demographics
NPI:1013582352
Name:POLK, CAYLA JAYE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAYLA
Middle Name:JAYE
Last Name:POLK
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SPRUCE KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36025-1146
Mailing Address - Country:US
Mailing Address - Phone:334-301-9521
Mailing Address - Fax:
Practice Address - Street 1:115 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3336
Practice Address - Country:US
Practice Address - Phone:334-491-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist