Provider Demographics
NPI:1972653079
Name:TRYLES, DARCI KLINE (MS)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:KLINE
Last Name:TRYLES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8085 RUBLE DR
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-9477
Mailing Address - Country:US
Mailing Address - Phone:269-383-4327
Mailing Address - Fax:269-978-0619
Practice Address - Street 1:3429 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-2214
Practice Address - Country:US
Practice Address - Phone:269-383-4327
Practice Address - Fax:269-978-0619
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000379231H00000X, 231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI)C90500OtherBCBS HEARING AIDS
MI383552896050Medicaid
MI19616Medicaid
MI19616Medicaid