Provider Demographics
NPI:1790331429
Name:DEAL, KYLEE RAE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:RAE
Last Name:DEAL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1429
Mailing Address - Country:US
Mailing Address - Phone:814-541-4848
Mailing Address - Fax:
Practice Address - Street 1:2026 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9711
Practice Address - Country:US
Practice Address - Phone:440-275-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2021-06-02
Deactivation Date:2021-03-27
Deactivation Code:
Reactivation Date:2021-05-10
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20191107-SP390200000X
OHSP.14007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty