Provider Demographics
NPI:1487213146
Name:ONDERKO, KAYLEE JANET (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:JANET
Last Name:ONDERKO
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 CHEVY CHASE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1599
Mailing Address - Country:US
Mailing Address - Phone:512-806-1630
Mailing Address - Fax:
Practice Address - Street 1:7600 CHEVY CHASE DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1599
Practice Address - Country:US
Practice Address - Phone:512-806-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577162Medicaid