Provider Demographics
NPI:1114760048
Name:COLETTA, KAYLEY (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:
Last Name:COLETTA
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 TIMBER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5349
Mailing Address - Country:US
Mailing Address - Phone:513-423-9496
Mailing Address - Fax:
Practice Address - Street 1:4710 TIMBER TRAIL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5349
Practice Address - Country:US
Practice Address - Phone:513-423-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20242709-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist