Provider Demographics
NPI:1578291860
Name:MOLINA, KAELA
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4329
Mailing Address - Country:US
Mailing Address - Phone:512-644-1588
Mailing Address - Fax:
Practice Address - Street 1:1351 SADLER DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7775
Practice Address - Country:US
Practice Address - Phone:512-805-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2024-02-23
Deactivation Date:2022-08-12
Deactivation Code:
Reactivation Date:2023-03-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program