Provider Demographics
NPI:1184241077
Name:LYLE, ANNA-LEIGH (SLP)
Entity type:Individual
Prefix:
First Name:ANNA-LEIGH
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANNA-LEIGH
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1397 S LINDEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4194
Mailing Address - Country:US
Mailing Address - Phone:810-230-9750
Mailing Address - Fax:810-230-8799
Practice Address - Street 1:1397 S LINDEN RD STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4194
Practice Address - Country:US
Practice Address - Phone:810-230-9750
Practice Address - Fax:810-230-8799
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7151001745246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7151001745OtherSTATE LICENSE