Provider Demographics
NPI:1114549078
Name:CLATT, RYLIE A
Entity Type:Individual
Prefix:
First Name:RYLIE
Middle Name:A
Last Name:CLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COLO
Mailing Address - State:IA
Mailing Address - Zip Code:50056-1027
Mailing Address - Country:US
Mailing Address - Phone:712-304-1667
Mailing Address - Fax:
Practice Address - Street 1:401 3RD ST SW
Practice Address - Street 2:
Practice Address - City:STATE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50247-7728
Practice Address - Country:US
Practice Address - Phone:712-304-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IA101046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty