Provider Demographics
NPI:1336793975
Name:INGRAHAM, KAYLEE (SLP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E HALLER AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1029
Mailing Address - Country:US
Mailing Address - Phone:253-549-6171
Mailing Address - Fax:
Practice Address - Street 1:505 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1404
Practice Address - Country:US
Practice Address - Phone:253-549-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60913327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist