Provider Demographics
NPI:1609648252
Name:DODSON, KYLIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ELIZABETH
Last Name:DODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 W OCEAN AIR DR APT 261
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4623
Mailing Address - Country:US
Mailing Address - Phone:281-323-3873
Mailing Address - Fax:
Practice Address - Street 1:2060 OTAY LAKES RD # 270
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1364
Practice Address - Country:US
Practice Address - Phone:619-546-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist