Healthcare Provider Details

I. General information

NPI: 1689012346
Provider Name (Legal Business Name): KAYLA RICHARDSON M.S., CCC-SLP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11777 GRAVOIS RD STE B
SAINT LOUIS MO
63127-1822
US

IV. Provider business mailing address

136 TIMBERCREST RD
KIRKWOOD MO
63122-1312
US

V. Phone/Fax

Practice location:
  • Phone: 314-252-0153
  • Fax:
Mailing address:
  • Phone: 217-257-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2016044882
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-307454
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: