Provider Demographics
NPI:1104530922
Name:VAN VLIET, KAYLEE JOYCE
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:JOYCE
Last Name:VAN VLIET
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:JOYCE
Other - Last Name:SCHOLTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1608 S CAMPBELL TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3364
Mailing Address - Country:US
Mailing Address - Phone:209-665-5604
Mailing Address - Fax:
Practice Address - Street 1:1000 S EDWARD DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-2932
Practice Address - Country:US
Practice Address - Phone:605-367-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1139-PROV235Z00000X
SD1347-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist