Provider Demographics
NPI:1942480710
Name:WYLIE, KATHY ANN (MA, SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:WYLIE
Suffix:
Gender:F
Credentials:MA, SLP/CCC
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SLP/CCC
Mailing Address - Street 1:4173 BAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2401
Mailing Address - Country:US
Mailing Address - Phone:716-821-0546
Mailing Address - Fax:
Practice Address - Street 1:50 E NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1002
Practice Address - Country:US
Practice Address - Phone:716-885-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016674-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist