Provider Demographics
NPI:1497530323
Name:RENDON-ORTIZ, KAYLA M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:RENDON-ORTIZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:RENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 LASER RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4517
Mailing Address - Country:US
Mailing Address - Phone:505-962-1242
Mailing Address - Fax:
Practice Address - Street 1:500 LASER RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4517
Practice Address - Country:US
Practice Address - Phone:505-962-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP6289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist