Provider Demographics
NPI:1275021438
Name:O'DORAN, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:O'DORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP-ASSISTANT
Mailing Address - Street 1:PO BOX 1944
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-1944
Mailing Address - Country:US
Mailing Address - Phone:903-407-6866
Mailing Address - Fax:
Practice Address - Street 1:5707 COUNTRYSIDE DRIVE NORTHEAST
Practice Address - Street 2:201
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-6228
Practice Address - Country:US
Practice Address - Phone:903-407-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399892355S0801X
OR17229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant