Provider Demographics
NPI:1760227342
Name:SAM, KAILLA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAILLA
Middle Name:
Last Name:SAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 S LEWIS CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-1137
Mailing Address - Country:US
Mailing Address - Phone:303-875-2431
Mailing Address - Fax:
Practice Address - Street 1:9197 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5112
Practice Address - Country:US
Practice Address - Phone:720-358-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist