Individual
KAELAN MYLO HENMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
204 GREENRIDGE DR, BELLEFONTAINE, OH 43311-2750
(419) 270-4796
Mailing address
204 GREENRIDGE DR, BELLEFONTAINE, OH 43311-2750
(419) 270-4796
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
7101005768
—
235Z00000X
Speech-Language Pathologist
Primary
SP.13402
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7101005768
LICENSE
MI
01
—
SP.13402
LICENSE
OH
Enumeration date
10/28/2019
Last updated
05/12/2025
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