Provider Demographics
NPI:1427633403
Name:WATERS, KAYLA RENEE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEE
Last Name:WATERS
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 1:411 WOOD RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5435
Mailing Address - Country:US
Mailing Address - Phone:864-612-3584
Mailing Address - Fax:
Practice Address - Street 1:420 THE PKWY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5204
Practice Address - Country:US
Practice Address - Phone:864-244-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist