Provider Demographics
NPI:1942799770
Name:BECKER, KYLIE M (MA, TSSLD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:M
Last Name:BECKER
Suffix:
Gender:F
Credentials:MA, TSSLD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2308
Mailing Address - Country:US
Mailing Address - Phone:646-826-8174
Mailing Address - Fax:
Practice Address - Street 1:7 BEAVER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004
Practice Address - Country:US
Practice Address - Phone:646-826-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist