Provider Demographics
NPI:1952012197
Name:O'BRIEN, KAYLEE BROOKE (SLP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:BROOKE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1953
Mailing Address - Country:US
Mailing Address - Phone:636-465-0726
Mailing Address - Fax:636-465-0747
Practice Address - Street 1:130 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1953
Practice Address - Country:US
Practice Address - Phone:636-465-0726
Practice Address - Fax:636-465-0747
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022041817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist