Individual provider Active NPI

Kayla Marie Kueny, MS. CCC-SLP

  • Speech-Language Pathologist
  • Mexico, MO
National Provider Identifier
1205296787
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2015040106 Issued in MO
Practice address
1 Veterans Way
Mexico, MO 65265-3379
Phone
(573) 581-1088
NPI assigned
Feb 26, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2015040106 MO Primary

Addresses

Primary practice location

1 Veterans Way
Mexico, MO 65265-3379

Mailing address

101 E State St
Kennett Square, PA 19348-3109

Other practice location 1

101 E State St
Kennett Square, PA 19348-3109
Phone (660) 385-2118

Other names 1

  • Kayla Marie Wilson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230123001902 MO Practitioner - Qualified Speech Language Pathologist 0941671358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Powerback Rehabilitation LLCGroup PAC ID 2365359932, 600 clinicians
Synergy Care Southeast LLCGroup PAC ID 6204079163, 193 clinicians

Practice addresses (Care Compare)

Festus, MO 63028
Phone (610) 925-1176

12399 Gravois Rd
Saint Louis, MO 63127-1736
Phone (337) 310-8500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2015040106MOMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Powerback Rehabilitation LLC Speech-Language Pathologist CurrentSince Mar 8, 2025 Accepting new patients
Powerback Rehabilitation LLC Speech-Language Pathologist CurrentSince Mar 8, 2025 Accepting new patients

Locations

101 E State St
Kennett Square, PA 19348
Phone (610) 925-4436

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1205296787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS WAY",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652653379",
            "telephone_number": "573-581-1088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 E State St",
            "address_purpose": "LOCATION",
            "city": "Kennett Square",
            "state": "PA",
            "postal_code": "193483109",
            "country_code": "US",
            "telephone_number": "660-385-2118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUENY",
        "first_name": "KAYLA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MS. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-26",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2015040106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLA",
            "last_name": "WILSON",
            "middle_name": "MARIE",
            "credential": "MS.CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mexico, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.