Healthcare Provider Details

I. General information

NPI: 1528973179
Provider Name (Legal Business Name): KAYLA WHITEHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 LYNDALE AVE S
RICHFIELD MN
55423-2313
US

IV. Provider business mailing address

2394 MANUELA DR
CHASKA MN
55318-1290
US

V. Phone/Fax

Practice location:
  • Phone: 952-285-2840
  • Fax:
Mailing address:
  • Phone: 715-891-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLICC-4479
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: