Provider Demographics
NPI:1295576577
Name:PITZER, RYLEE ALEXA (CF-SLP)
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:ALEXA
Last Name:PITZER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 EVERETT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2202
Mailing Address - Country:US
Mailing Address - Phone:502-767-5454
Mailing Address - Fax:
Practice Address - Street 1:10330 BUNSEN WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2508
Practice Address - Country:US
Practice Address - Phone:502-495-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY292204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist