Provider Demographics
NPI:1730734906
Name:LUDLOW, KAILIE MICHELE (SLPA)
Entity type:Individual
Prefix:
First Name:KAILIE
Middle Name:MICHELE
Last Name:LUDLOW
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 E CABORCA DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6382
Mailing Address - Country:US
Mailing Address - Phone:520-518-1595
Mailing Address - Fax:
Practice Address - Street 1:1556 N ARIZOLA RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5746
Practice Address - Country:US
Practice Address - Phone:520-518-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA119202355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant