Provider Demographics
NPI:1427573245
Name:WAKEMAN, KAYLA G (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:G
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 ANN ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-4109
Mailing Address - Country:US
Mailing Address - Phone:989-860-0003
Mailing Address - Fax:
Practice Address - Street 1:4900 HEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-1928
Practice Address - Country:US
Practice Address - Phone:989-631-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program