Provider Demographics
NPI:1649017369
Name:MAHLER, KAILEA JAY HART (SLP)
Entity type:Individual
Prefix:
First Name:KAILEA
Middle Name:JAY HART
Last Name:MAHLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KAILEA
Other - Middle Name:JAY HART
Other - Last Name:MESSENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 NE HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7450
Mailing Address - Country:US
Mailing Address - Phone:503-666-1333
Mailing Address - Fax:
Practice Address - Street 1:304 NE HOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7450
Practice Address - Country:US
Practice Address - Phone:503-666-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist