Provider Demographics
NPI:1114645827
Name:ROHRLACK, KAILEY MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:MARIE
Last Name:ROHRLACK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 DR MARTIN LUTHER KING JR ST N APT 20107
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1640
Mailing Address - Country:US
Mailing Address - Phone:772-323-6296
Mailing Address - Fax:
Practice Address - Street 1:7108 N DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5406
Practice Address - Country:US
Practice Address - Phone:772-323-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist