Provider Demographics
NPI:1740958271
Name:LICHTMAN, KAYLA MORGAN (CCC SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MORGAN
Last Name:LICHTMAN
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 GREENBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2306
Mailing Address - Country:US
Mailing Address - Phone:516-503-8511
Mailing Address - Fax:
Practice Address - Street 1:2860 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1125
Practice Address - Country:US
Practice Address - Phone:516-396-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL235Z00000X
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist