Provider Demographics
NPI:1447805734
Name:LYONS, KYLA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:
Other - Last Name:LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 S JEFFERSON ST APT 5H
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-8443
Mailing Address - Country:US
Mailing Address - Phone:317-513-0645
Mailing Address - Fax:
Practice Address - Street 1:101 S KRAEMER BLVD STE 136
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6190
Practice Address - Country:US
Practice Address - Phone:714-528-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist