Provider Demographics
NPI:1245773381
Name:MICHAEL, KAYCEE RAE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KAYCEE
Middle Name:RAE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 E MINNESOTA ST
Mailing Address - Street 2:APT C
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8327
Mailing Address - Country:US
Mailing Address - Phone:605-660-5783
Mailing Address - Fax:
Practice Address - Street 1:893 E MINNESOTA ST
Practice Address - Street 2:APT C
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8327
Practice Address - Country:US
Practice Address - Phone:605-660-5783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD626-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist