Provider Demographics
NPI:1295482396
Name:PETREHN, KAILEY MAE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:MAE
Last Name:PETREHN
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 1:1445 N 600 RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-7258
Mailing Address - Country:US
Mailing Address - Phone:217-725-7902
Mailing Address - Fax:
Practice Address - Street 1:1445 N 600 RD
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-7258
Practice Address - Country:US
Practice Address - Phone:217-725-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist