Provider Demographics
NPI:1538702667
Name:LYTLE, CHARLIE C (MSCCCSLP)
Entity Type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:C
Last Name:LYTLE
Suffix:
Gender:M
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 HAYWOOD RD STE H
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-7111
Mailing Address - Country:US
Mailing Address - Phone:828-774-5222
Mailing Address - Fax:
Practice Address - Street 1:185 BRICK FARM RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779
Practice Address - Country:US
Practice Address - Phone:828-556-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist