Individual
MRS. KAYLA MARIE JISKOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
404 JEFFERSON ST, PELLA, IA 50219-1257
(641) 628-6623
Mailing address
404 JEFFERSON ST, PELLA, IA 50219-1257
(641) 628-6623
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
001760
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001760
IOWA LICENSE
IA
01
—
1518105261
NPI NUMBER
—
Enumeration date
02/02/2009
Last updated
04/29/2016
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