Provider Demographics
NPI:1093598229
Name:LEE, KAYLA (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHANCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-3290
Mailing Address - Country:US
Mailing Address - Phone:207-551-5750
Mailing Address - Fax:
Practice Address - Street 1:16 CHANCE DR
Practice Address - Street 2:
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-3290
Practice Address - Country:US
Practice Address - Phone:207-551-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist