Provider Demographics
NPI:1518105261
Name:JISKOOT, KAYLA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MARIE
Last Name:JISKOOT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1257
Mailing Address - Country:US
Mailing Address - Phone:641-628-6623
Mailing Address - Fax:
Practice Address - Street 1:404 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1257
Practice Address - Country:US
Practice Address - Phone:641-628-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001760OtherIOWA LICENSE
1518105261OtherNPI NUMBER