Provider Demographics
NPI:1619606407
Name:SANDLIN, KAYLA MARIE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARIE
Other - Last Name:MCKIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:6801 W 20TH ST UNIT 212
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9640
Mailing Address - Country:US
Mailing Address - Phone:970-301-4206
Mailing Address - Fax:
Practice Address - Street 1:6801 W 20TH ST UNIT 212
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9640
Practice Address - Country:US
Practice Address - Phone:970-301-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14315348235Z00000X
COSLP.0004691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist