Provider Demographics
NPI:1134685381
Name:SALAN, KAYLA RENAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENAE
Last Name:SALAN
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 1:4802 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1433
Mailing Address - Country:US
Mailing Address - Phone:940-228-7810
Mailing Address - Fax:
Practice Address - Street 1:4802 ELDORADO DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1433
Practice Address - Country:US
Practice Address - Phone:940-228-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist