Provider Demographics
NPI:1881204865
Name:KING, KAYLEY GRACE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAYLEY
Middle Name:GRACE
Last Name:KING
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:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-0346
Mailing Address - Country:US
Mailing Address - Phone:276-694-3163
Mailing Address - Fax:
Practice Address - Street 1:3003 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:MEADOWS OF DAN
Practice Address - State:VA
Practice Address - Zip Code:24120-4197
Practice Address - Country:US
Practice Address - Phone:276-952-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000527235Z00000X
VA2202010220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist