Provider Demographics
NPI:1871905208
Name:HOLLINGSWORTH, KAYLEA HARDIN (SLP)
Entity type:Individual
Prefix:
First Name:KAYLEA
Middle Name:HARDIN
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KAYLEA
Other - Middle Name:DANEAN
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP INTERN
Mailing Address - Street 1:555 W 8TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6552
Mailing Address - Country:US
Mailing Address - Phone:904-244-1484
Mailing Address - Fax:904-244-1180
Practice Address - Street 1:555 W 8TH ST FL 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6552
Practice Address - Country:US
Practice Address - Phone:817-920-0484
Practice Address - Fax:817-920-0068
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110000390200000X
FLSA15187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program