Healthcare Provider Details

I. General information

NPI: 1013871995
Provider Name (Legal Business Name): KAYLA NICOLE COX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 12TH AVE S
MOORHEAD MN
56560-8100
US

IV. Provider business mailing address

643 S SEDONA DR
WEST FARGO ND
58078-8135
US

V. Phone/Fax

Practice location:
  • Phone: 218-284-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number455158
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: