Provider Demographics
NPI:1205475639
Name:RIDDLE, KAYLA MARIE (BS,SLPA)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MARIE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:BS,SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N PRICKETT RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7511
Mailing Address - Country:US
Mailing Address - Phone:501-213-0594
Mailing Address - Fax:
Practice Address - Street 1:2700 N PRICKETT RD STE 2B
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7511
Practice Address - Country:US
Practice Address - Phone:501-213-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty