Provider Demographics
NPI:1649939760
Name:GIADROSICH, KAYLEN
Entity type:Individual
Prefix:
First Name:KAYLEN
Middle Name:
Last Name:GIADROSICH
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 1:5738 TIGER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-7775
Mailing Address - Country:US
Mailing Address - Phone:850-572-7987
Mailing Address - Fax:
Practice Address - Street 1:5738 TIGER WOODS DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-7775
Practice Address - Country:US
Practice Address - Phone:850-572-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist