Provider Demographics
NPI:1164902490
Name:SULLIVAN, KAYLA DANIELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:DANIELLE
Last Name:SULLIVAN
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 1:71 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1954
Mailing Address - Country:US
Mailing Address - Phone:716-785-9112
Mailing Address - Fax:
Practice Address - Street 1:7755 ROUTE 83
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTON
Practice Address - State:NY
Practice Address - Zip Code:14138-9633
Practice Address - Country:US
Practice Address - Phone:716-988-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist