Provider Demographics
NPI:1447952338
Name:STUDT, KAILA M
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:M
Last Name:STUDT
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 1:100 W GREENTREE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4009
Mailing Address - Country:US
Mailing Address - Phone:636-346-6773
Mailing Address - Fax:
Practice Address - Street 1:100 W GREENTREE LN
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4009
Practice Address - Country:US
Practice Address - Phone:636-346-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2015002777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional