Provider Demographics
NPI:1669751244
Name:HERNANDEZ, KAYLA O (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:O
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:LO-367
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6460
Mailing Address - Fax:617-730-0611
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:LO-367
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6460
Practice Address - Fax:617-730-0611
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist