Provider Demographics
NPI:1235822560
Name:OAKS, KAYLA A (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:A
Last Name:OAKS
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 1:42 PIER PL
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4918
Mailing Address - Country:US
Mailing Address - Phone:801-574-5772
Mailing Address - Fax:
Practice Address - Street 1:42 PIER PL
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-4918
Practice Address - Country:US
Practice Address - Phone:801-574-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9151088-4102235Z00000X
CA31590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist