Provider Demographics
NPI:1245640721
Name:REYNOLDS, KAJUANDA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAJUANDA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7860 N GARDEN MANOR DR
Mailing Address - Street 2:105
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-6552
Mailing Address - Country:US
Mailing Address - Phone:662-417-5362
Mailing Address - Fax:
Practice Address - Street 1:5070 SANDERLIN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4332
Practice Address - Country:US
Practice Address - Phone:901-682-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist