Provider Demographics
NPI:1376815001
Name:RACIOPPO, KYLIE LAUREN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:LAUREN
Last Name:RACIOPPO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 GLENWOOD AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2355
Mailing Address - Country:US
Mailing Address - Phone:724-630-3868
Mailing Address - Fax:
Practice Address - Street 1:155 LAKE DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8406
Practice Address - Country:US
Practice Address - Phone:724-933-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist