Provider Demographics
NPI:1922238591
Name:ANGLE, KAILEE S (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAILEE
Middle Name:S
Last Name:ANGLE
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 1:3400 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-7708
Mailing Address - Country:US
Mailing Address - Phone:617-974-1114
Mailing Address - Fax:
Practice Address - Street 1:3400 E PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-7708
Practice Address - Country:US
Practice Address - Phone:469-752-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2355S0801X2355S0801X
TX108053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA477OtherCOMM OF MA DIVISION OF PROFESSIONAL LICENSURE SL PATHOLOGIST ASSISTANT LICENSE