Healthcare Provider Details

I. General information

NPI: 1225720477
Provider Name (Legal Business Name): KAYLA SHERRADEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA SHUFF

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date: 08/05/2026
Reactivation Date: 09/21/2026

III. Provider practice location address

639 N ATHERTON ST
MAIZE KS
67101-9658
US

IV. Provider business mailing address

639 N ATHERTON ST
MAIZE KS
67101-9658
US

V. Phone/Fax

Practice location:
  • Phone: 620-314-2273
  • Fax:
Mailing address:
  • Phone: 620-314-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number05511
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: