Provider Demographics
NPI:1144358474
Name:COLLINS, KAYLA SUE (CCC SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:SUE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:SUE
Other - Last Name:WAREHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:WESTPHALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65085-0037
Mailing Address - Country:US
Mailing Address - Phone:573-455-2375
Mailing Address - Fax:573-455-9884
Practice Address - Street 1:OSAGE COUNTY REORGANZIED SCHOOL DISTRICT R-III
Practice Address - Street 2:143 E MAIN
Practice Address - City:WESTPHALIA
Practice Address - State:MO
Practice Address - Zip Code:65085-0037
Practice Address - Country:US
Practice Address - Phone:573-455-2375
Practice Address - Fax:573-455-9884
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467493904Medicaid