Provider Demographics
NPI:1346251295
Name:CORDLE, KYRA H (SLP)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:H
Last Name:CORDLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W MATTHEWS ST
Mailing Address - Street 2:105
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5441
Mailing Address - Country:US
Mailing Address - Phone:803-981-2045
Mailing Address - Fax:
Practice Address - Street 1:1108 SIENNA SAND WAY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9349
Practice Address - Country:US
Practice Address - Phone:803-981-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist