Provider Demographics
NPI:1467203810
Name:REICHARD, KAYLA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:REICHARD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SOUTH LOGAN STREET SUITE M
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752
Mailing Address - Country:US
Mailing Address - Phone:828-559-2164
Mailing Address - Fax:
Practice Address - Street 1:602 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5823
Practice Address - Country:US
Practice Address - Phone:828-559-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist