Provider Demographics
NPI:1598775470
Name:WOOTEN, KYLE STEVEN (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:STEVEN
Last Name:WOOTEN
Suffix:
Gender:M
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 1:2270 US HWY 74A
Mailing Address - Street 2:SUITE 341
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043
Mailing Address - Country:US
Mailing Address - Phone:828-247-1588
Mailing Address - Fax:828-247-1692
Practice Address - Street 1:2270 US HWY 74A
Practice Address - Street 2:SUITE 341
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043
Practice Address - Country:US
Practice Address - Phone:828-247-1588
Practice Address - Fax:828-247-1692
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
138NWOtherBCBS