Provider Demographics
NPI:1265041164
Name:AUGENSTEIN, KAILEY JO (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:JO
Last Name:AUGENSTEIN
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 1:5170 AURORA AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-9104
Mailing Address - Country:US
Mailing Address - Phone:270-617-2193
Mailing Address - Fax:
Practice Address - Street 1:901 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1335
Practice Address - Country:US
Practice Address - Phone:920-648-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5133-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist