Provider Demographics
NPI:1902672991
Name:COLLINS, KAYLA SUE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:SUE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22206 MO 142
Mailing Address - Street 2:
Mailing Address - City:MYRTLE
Mailing Address - State:MO
Mailing Address - Zip Code:65778-8375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22206 MO 142
Practice Address - Street 2:
Practice Address - City:MYRTLE
Practice Address - State:MO
Practice Address - Zip Code:65778-8375
Practice Address - Country:US
Practice Address - Phone:417-938-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant