Provider Demographics
NPI:1629419874
Name:WYLIE, PAULA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:WYLIE
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 1:8615 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-3519
Mailing Address - Country:US
Mailing Address - Phone:440-665-6731
Mailing Address - Fax:
Practice Address - Street 1:8615 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-3519
Practice Address - Country:US
Practice Address - Phone:440-729-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4852235Z00000X
OHSP12016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist