Provider Demographics
NPI:1275015034
Name:SMITH, KAYLA LOUISE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 CHARMED WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-3312
Mailing Address - Country:US
Mailing Address - Phone:724-678-7395
Mailing Address - Fax:
Practice Address - Street 1:3412 MASSAPONAX CHURCH RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-8778
Practice Address - Country:US
Practice Address - Phone:540-834-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist