Provider Demographics
NPI:1508249871
Name:JONES, KAYLA G (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:G
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:BROOKE
Other - Last Name:GRANTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3162
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3162
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:98 NOCATEE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-6152
Practice Address - Country:US
Practice Address - Phone:904-202-4243
Practice Address - Fax:904-202-4639
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008155235Z00000X
FLSA14579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist