Healthcare Provider Details

I. General information

NPI: 1265041164
Provider Name (Legal Business Name): KAILEY JO AUGENSTEIN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15150 W MONDELL RD
SURPRISE AZ
85374-3434
US

IV. Provider business mailing address

15911 N 138TH AVE
SURPRISE AZ
85374-5357
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7600
  • Fax:
Mailing address:
  • Phone: 270-617-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP15464
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: