Provider Demographics
NPI:1447752191
Name:HOLKE, KAYLIE MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:MARIE
Last Name:HOLKE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KAYLIE
Other - Middle Name:
Other - Last Name:FERNALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2840 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5535
Mailing Address - Country:US
Mailing Address - Phone:949-293-2603
Mailing Address - Fax:
Practice Address - Street 1:2840 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5535
Practice Address - Country:US
Practice Address - Phone:949-293-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27458235Z00000X
CARPE11621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist