Provider Demographics
NPI:1689012346
Name:RICHARDSON, KAYLA (MS, CCC-SLP, IBCLC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 TIMBERCREST RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1312
Mailing Address - Country:US
Mailing Address - Phone:217-257-0070
Mailing Address - Fax:
Practice Address - Street 1:11777 GRAVOIS RD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1822
Practice Address - Country:US
Practice Address - Phone:314-252-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-307454174N00000X
MO2016044882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty