Healthcare Provider Details

I. General information

NPI: 1679174965
Provider Name (Legal Business Name): KAYLA HENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N27W5707 LINCOLN BLVD
CEDARBURG WI
53012-2852
US

IV. Provider business mailing address

1011 SUNNYSIDE AVE
AURORA IN
47001-1638
US

V. Phone/Fax

Practice location:
  • Phone: 262-376-7676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6419-154
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1611-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: