Provider Demographics
NPI:1346797651
Name:GRAHL, KYLA (SLP)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:GRAHL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 JEFFERSON ST STE 103A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4443
Mailing Address - Country:US
Mailing Address - Phone:636-283-0211
Mailing Address - Fax:
Practice Address - Street 1:13610 BARRETT OFFICE DR STE 104
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7818
Practice Address - Country:US
Practice Address - Phone:314-822-5107
Practice Address - Fax:314-822-5106
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015016738OtherSLP LICENSE#