Provider Demographics
NPI:1467890384
Name:BURNETT, KAYLA BROOKE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:BROOKE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2348
Mailing Address - Country:US
Mailing Address - Phone:850-875-2035
Mailing Address - Fax:
Practice Address - Street 1:16 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2348
Practice Address - Country:US
Practice Address - Phone:850-875-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist