Provider Demographics
NPI:1346399748
Name:LYON, KIM (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 FOXRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8215
Mailing Address - Country:US
Mailing Address - Phone:252-883-7968
Mailing Address - Fax:252-443-6851
Practice Address - Street 1:745 FOXRIDGE CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8215
Practice Address - Country:US
Practice Address - Phone:252-883-7968
Practice Address - Fax:252-443-6851
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist