Provider Demographics
NPI:1659962793
Name:MORSE-ROTH, KYLIE
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:MORSE-ROTH
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 1:14540 FARM TO MARKET RD 1325
Mailing Address - Street 2:APT #2725
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728
Mailing Address - Country:US
Mailing Address - Phone:512-487-0237
Mailing Address - Fax:
Practice Address - Street 1:14540 FM 1325
Practice Address - Street 2:APT #2725
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-7872
Practice Address - Country:US
Practice Address - Phone:512-487-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist