Provider Demographics
NPI:1285184903
Name:RECKNAGEL, KAILEN KATHERN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAILEN
Middle Name:KATHERN
Last Name:RECKNAGEL
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 1:3879 SINCLAIR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4450
Mailing Address - Country:US
Mailing Address - Phone:262-719-6337
Mailing Address - Fax:
Practice Address - Street 1:3879 SINCLAIR ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4450
Practice Address - Country:US
Practice Address - Phone:262-719-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9644235Z00000X
NVSP-3428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist