Provider Demographics
NPI:1679356521
Name:KIERNAN, KAYLA EILEEN (AUD CCC-A)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:EILEEN
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2170
Mailing Address - Country:US
Mailing Address - Phone:845-489-2247
Mailing Address - Fax:
Practice Address - Street 1:139 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1269
Practice Address - Country:US
Practice Address - Phone:860-570-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000745231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist