Provider Demographics
NPI:1851468151
Name:SLAUGHTER, KYLA MICHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:MICHELLE
Last Name:SLAUGHTER
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 1:1915 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2619
Mailing Address - Country:US
Mailing Address - Phone:972-838-6240
Mailing Address - Fax:
Practice Address - Street 1:1915 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2619
Practice Address - Country:US
Practice Address - Phone:972-838-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528419OtherBLUE CROSS BLUE SHIELD