Healthcare Provider Details

I. General information

NPI: 1164107405
Provider Name (Legal Business Name): KAYLEE ANN WOODSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8139 W SALTER DR
PEORIA AZ
85382-4407
US

IV. Provider business mailing address

8139 W SALTER DR
PEORIA AZ
85382-4407
US

V. Phone/Fax

Practice location:
  • Phone: 623-640-5146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17237
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: