Provider Demographics
NPI:1043864721
Name:KYLE, CARA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-0674
Mailing Address - Country:US
Mailing Address - Phone:612-888-4757
Mailing Address - Fax:763-486-1367
Practice Address - Street 1:12732 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9342
Practice Address - Country:US
Practice Address - Phone:612-888-4757
Practice Address - Fax:763-486-1367
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist