Provider Demographics
NPI:1447702824
Name:KOLHEDE, KAYLA MAY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MAY
Last Name:KOLHEDE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MAY
Other - Last Name:GOGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2452 WATSON CT
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3216
Mailing Address - Country:US
Mailing Address - Phone:650-498-4327
Mailing Address - Fax:650-736-4327
Practice Address - Street 1:2452 WATSON CT
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303
Practice Address - Country:US
Practice Address - Phone:650-498-4327
Practice Address - Fax:650-736-4327
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist