Provider Demographics
NPI:1265881817
Name:EBELING, KYLIE ELIZABETH (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:ELIZABETH
Last Name:EBELING
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 1:25117 SW PARKWAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 2ND ST
Practice Address - Street 2:
Practice Address - City:DODGE
Practice Address - State:NE
Practice Address - Zip Code:68633-3555
Practice Address - Country:US
Practice Address - Phone:402-693-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist