Provider Demographics
NPI:1649579301
Name:CLEMONS, KYLA YVONNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:YVONNE
Last Name:CLEMONS
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 1:3909 WARRINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-0221
Mailing Address - Country:US
Mailing Address - Phone:405-579-4465
Mailing Address - Fax:
Practice Address - Street 1:3909 WARRINGTON WAY
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-0221
Practice Address - Country:US
Practice Address - Phone:405-579-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist