Provider Demographics
NPI:1033729355
Name:HALLER, KYLEE MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:MARIE
Last Name:HALLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LOMBARD ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1414
Mailing Address - Country:US
Mailing Address - Phone:215-893-2500
Mailing Address - Fax:215-893-2501
Practice Address - Street 1:1800 LOMBARD ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1414
Practice Address - Country:US
Practice Address - Phone:215-893-2500
Practice Address - Fax:215-893-2501
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist