Provider Demographics
NPI:1235486317
Name:HOMSTAD, KAYLEE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:HOMSTAD
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E MAIN ST
Mailing Address - Street 2:#101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63 E MAIN ST
Practice Address - Street 2:#101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7417
Practice Address - Country:US
Practice Address - Phone:480-472-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP7842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist