Provider Demographics
NPI:1750036885
Name:STANDEN, KAYLA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:STANDEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459-965 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96114-9498
Mailing Address - Country:US
Mailing Address - Phone:775-772-9136
Mailing Address - Fax:
Practice Address - Street 1:459-965 LAKE VIEW DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:CA
Practice Address - Zip Code:96114-9498
Practice Address - Country:US
Practice Address - Phone:775-772-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15513235Z00000X
NVSP-3170235Z00000X
GASLP011963235Z00000X
CA34605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist