Healthcare Provider Details

I. General information

NPI: 1649198086
Provider Name (Legal Business Name): KAILA JENEE JEFFERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2032 GAINES ST
COVINGTON GA
30016-5805
US

IV. Provider business mailing address

2032 GAINES ST
COVINGTON GA
30016-5805
US

V. Phone/Fax

Practice location:
  • Phone: 757-418-2590
  • Fax:
Mailing address:
  • Phone: 757-418-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10889
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP36403
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP011746
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: