Provider Demographics
NPI:1295574572
Name:FABRIZIUS, KAILEY
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:FABRIZIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9343 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5016
Mailing Address - Country:US
Mailing Address - Phone:712-202-6089
Mailing Address - Fax:
Practice Address - Street 1:602 VISIONS PKWY
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1672
Practice Address - Country:US
Practice Address - Phone:515-642-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist