Provider Demographics
NPI:1679743272
Name:HARA, KENYE GAYLETTE
Entity Type:Individual
Prefix:
First Name:KENYE
Middle Name:GAYLETTE
Last Name:HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENYE
Other - Middle Name:GAYLETTE
Other - Last Name:NORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19230 WYANDOTTE ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3578
Mailing Address - Country:US
Mailing Address - Phone:818-345-4840
Mailing Address - Fax:
Practice Address - Street 1:13400 RIVERSIDE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2500
Practice Address - Country:US
Practice Address - Phone:818-783-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist