Provider Demographics
NPI:1821332206
Name:LAUSELL, KAILA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:M
Last Name:LAUSELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12595 SW 137TH AVE
Mailing Address - Street 2:SUITE 303&305
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4220
Mailing Address - Country:US
Mailing Address - Phone:786-219-0151
Mailing Address - Fax:786-219-3920
Practice Address - Street 1:12595 SW 137TH AVE
Practice Address - Street 2:SUITE 303&305
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4220
Practice Address - Country:US
Practice Address - Phone:786-219-0151
Practice Address - Fax:786-219-3920
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007766800Medicaid