Provider Demographics
NPI:1689451973
Name:WHITE, KYLIE (MS, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:KYLIE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2245
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70511-2245
Mailing Address - Country:US
Mailing Address - Phone:337-212-1190
Mailing Address - Fax:
Practice Address - Street 1:1502 SYLVESTER ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-7441
Practice Address - Country:US
Practice Address - Phone:337-893-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist