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General NPI Number Information
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NPI Number | 1952012197
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Entity Type | Individual
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Provider Name | KAYLEE BROOKE O'BRIEN SLP
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Gender | Female
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 130 MAIN ST STE 7
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City | FESTUS
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State | MO
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Zip | 63028-1953
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Country | US
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Telephone | 636-465-0726
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Fax | 636-465-0747
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Provider Business Mailing Address
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Address Line | 130 MAIN ST STE 7
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City | FESTUS
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State | MO
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Zip | 63028-1953
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Country | US
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Telephone | 636-465-0726
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Fax | 636-465-0747
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2022041817
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License Number State | MO
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