Provider Demographics
NPI:1386902955
Name:STANEK, KAYLA LYNN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:STANEK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9507 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-3118
Mailing Address - Country:US
Mailing Address - Phone:315-269-7653
Mailing Address - Fax:
Practice Address - Street 1:9507 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:SAUQUOIT
Practice Address - State:NY
Practice Address - Zip Code:13456-3118
Practice Address - Country:US
Practice Address - Phone:315-269-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021873-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist