MEDICARE: KAYLEE GRACE BAGLEY M.ED, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP013983	GA

General Provider Information

NPI Number	:	1215741152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE GRACE BAGLEY M.ED, CCC-SLP

Provider Business Mailing Address
First Line	:	5109 NORTHWIND BLVD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-7674
Country	:	US
Telephone Number	:	229-244-1667
Fax Number	:	229-244-8253

Provider Business Practice Location Address
First Line	:	5109 NORTHWIND BLVD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-7674
Country	:	US
Telephone Number	:	229-244-1667
Fax Number	:	229-244-8253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/05/2026

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Directions to “ KAYLEE GRACE BAGLEY M.ED, CCC-SLP” Practice Location

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