Provider Demographics
NPI:1306737903
Name:KICINSKI, KAILEE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:KICINSKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55203 KILKENNY WAY # 55203
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-0047
Mailing Address - Country:US
Mailing Address - Phone:704-224-3797
Mailing Address - Fax:
Practice Address - Street 1:1401 S RIDGE AVE
Practice Address - Street 2:1401 S RIDGE AVE
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6056
Practice Address - Country:US
Practice Address - Phone:980-242-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30004163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist