Provider Demographics
NPI:1518250059
Name:LUTTRELL, KAYLEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4034
Mailing Address - Country:US
Mailing Address - Phone:479-659-1899
Mailing Address - Fax:
Practice Address - Street 1:5305 W VILLAGE PKWY STE 9
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:478-401-2077
Practice Address - Fax:479-358-9943
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAPPLIED235Z00000X
ARSP#3120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist