Healthcare Provider Details

I. General information

NPI: 1447185590
Provider Name (Legal Business Name): MISS KAYLIN LEVIAN STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 N 35TH AVE STE 109
PHOENIX AZ
85029-3213
US

IV. Provider business mailing address

2302 E GLENROSA AVE
PHOENIX AZ
85016-6214
US

V. Phone/Fax

Practice location:
  • Phone: 602-780-1179
  • Fax:
Mailing address:
  • Phone: 602-491-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17384
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: