Provider Demographics
NPI:1437600798
Name:TIERNEY, KAYLA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:HALSALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 LAURELHURST RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-8143
Mailing Address - Country:US
Mailing Address - Phone:401-486-8206
Mailing Address - Fax:
Practice Address - Street 1:18 LAURELHURST RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-8143
Practice Address - Country:US
Practice Address - Phone:401-486-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8874235Z00000X
RISP01280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISP01280OtherPRIVATE PAY
RISP01280Medicaid