Provider Demographics
NPI:1700261047
Name:BAUER, KAYLIN (MS)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KAYLIN
Other - Middle Name:
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:151 N SUNRISE AVE STE 1105
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2931
Mailing Address - Country:US
Mailing Address - Phone:916-771-8255
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 1105
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2931
Practice Address - Country:US
Practice Address - Phone:916-771-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist