Provider Demographics
NPI:1619449709
Name:COOK, KYLIE ERIN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:ERIN
Last Name:COOK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 BUSINESS 220
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1120
Mailing Address - Country:US
Mailing Address - Phone:724-859-4631
Mailing Address - Fax:
Practice Address - Street 1:208 PENNKNOLL RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-6940
Practice Address - Country:US
Practice Address - Phone:814-623-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist