Provider Demographics
NPI:1821401894
Name:MANSFIELD, KYLIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:
Last Name:MANSFIELD
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 1:1013 ALICIA LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2505
Mailing Address - Country:US
Mailing Address - Phone:931-231-5273
Mailing Address - Fax:
Practice Address - Street 1:1511 NASHVILLE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2070
Practice Address - Country:US
Practice Address - Phone:931-490-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist