Provider Demographics
NPI:1053053017
Name:VANDERLAAN, KAYLA MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:VANDERLAAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9728
Mailing Address - Country:US
Mailing Address - Phone:616-389-9242
Mailing Address - Fax:
Practice Address - Street 1:570 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1323
Practice Address - Country:US
Practice Address - Phone:616-447-7799
Practice Address - Fax:616-724-4117
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist