Provider Demographics
NPI:1700332244
Name:DALEY, KAYLEIGH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:DALEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:SAWALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2516 S 134TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3114
Mailing Address - Country:US
Mailing Address - Phone:414-530-3372
Mailing Address - Fax:
Practice Address - Street 1:2516 S 134TH ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3114
Practice Address - Country:US
Practice Address - Phone:414-530-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
WI4301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700332244Medicaid