Provider Demographics
NPI:1780150227
Name:GOEHRING, KAYLA NICOLE (CF-SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:GOEHRING
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7688 SALIX PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3772
Mailing Address - Country:US
Mailing Address - Phone:858-603-2257
Mailing Address - Fax:
Practice Address - Street 1:8755 AERO DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1750
Practice Address - Country:US
Practice Address - Phone:619-578-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14277OtherCA LICENSE NUMVER