Provider Demographics
NPI:1699171595
Name:ROGERS STOUT, KAYLA (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ROGERS STOUT
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8459 LEXIE LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5796
Mailing Address - Country:US
Mailing Address - Phone:229-318-9594
Mailing Address - Fax:
Practice Address - Street 1:37 BROCK DR
Practice Address - Street 2:
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30750-2207
Practice Address - Country:US
Practice Address - Phone:229-318-9594
Practice Address - Fax:423-702-4493
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist