Provider Demographics
NPI:1083075444
Name:COYLE, KENYA (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 W MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1877
Mailing Address - Country:US
Mailing Address - Phone:580-920-4605
Mailing Address - Fax:580-931-0525
Practice Address - Street 1:1270 W MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-1877
Practice Address - Country:US
Practice Address - Phone:580-920-4605
Practice Address - Fax:580-931-0525
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist