Provider Demographics
NPI:1508886110
Name:ACKLES, KYLEE SUE (MS,ED-SLP)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:SUE
Last Name:ACKLES
Suffix:
Gender:F
Credentials:MS,ED-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 CAMP SIENNA TRAIL
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:281-634-3950
Mailing Address - Fax:
Practice Address - Street 1:460 PLANTAION DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-480-0333
Practice Address - Fax:979-480-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist