Provider Demographics
NPI:1083221238
Name:DOMINO, KALEIGH (MSED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:DOMINO
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 NATHANS TRL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9377
Mailing Address - Country:US
Mailing Address - Phone:716-868-4908
Mailing Address - Fax:
Practice Address - Street 1:2980 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1918
Practice Address - Country:US
Practice Address - Phone:716-892-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist