Basic Information
| Provider Information | |||||||||
| NPI: | 1669996237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELLING | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | KAREN | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3776 GLASER DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454294116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246785226 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3449 NEWMARK DR | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453425426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372811286 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 262291 | KY | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP12987 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | AB7360731 | 01 | OH | MEDICARE PIN | OTHER | 2187155 | 05 | OH | MEDICAID |