Provider Demographics
NPI:1225923089
Name:ROSE, KAYLEE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JASON WITTEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2970
Mailing Address - Country:US
Mailing Address - Phone:423-439-4355
Mailing Address - Fax:
Practice Address - Street 1:1000 JASON WITTEN WAY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2970
Practice Address - Country:US
Practice Address - Phone:423-439-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist