Provider Demographics
NPI:1093509713
Name:FAIRCLOUGH, KAILEE
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:FAIRCLOUGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KAILEE
Other - Middle Name:P
Other - Last Name:KEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13329 FALL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2431
Mailing Address - Country:US
Mailing Address - Phone:785-592-1120
Mailing Address - Fax:
Practice Address - Street 1:4205 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-7802
Practice Address - Country:US
Practice Address - Phone:214-357-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist