Provider Demographics
NPI:1710500178
Name:KREMMEL, KILEY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:KREMMEL
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 1:528 E SPOKANE FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5081
Mailing Address - Country:US
Mailing Address - Phone:509-465-1252
Mailing Address - Fax:
Practice Address - Street 1:1308 CHERRY DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5923
Practice Address - Country:US
Practice Address - Phone:406-581-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-8800235Z00000X
WALL61066761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist