Provider Demographics
NPI:1295456663
Name:KNELL, KYLEIGH BROOKE
Entity type:Individual
Prefix:
First Name:KYLEIGH
Middle Name:BROOKE
Last Name:KNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HOPEWELL CT
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-2101
Mailing Address - Country:US
Mailing Address - Phone:443-553-5290
Mailing Address - Fax:
Practice Address - Street 1:500 HOPEWELL RD
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2134
Practice Address - Country:US
Practice Address - Phone:410-658-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14442375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist