Provider Demographics
NPI:1538877618
Name:RASTGOO, KAYLA FELICE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:FELICE
Last Name:RASTGOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 WOODLAND PARK AVE N APT 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7459
Mailing Address - Country:US
Mailing Address - Phone:562-714-1435
Mailing Address - Fax:
Practice Address - Street 1:12727 NORTHUP WAY STE 1
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1917
Practice Address - Country:US
Practice Address - Phone:425-533-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61335536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist