Provider Demographics
NPI:1356691216
Name:ARCHBOLD, KYLE (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:ARCHBOLD
Suffix:
Gender:M
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 1:609 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:ENDERLIN
Mailing Address - State:ND
Mailing Address - Zip Code:58027-1357
Mailing Address - Country:US
Mailing Address - Phone:701-678-5128
Mailing Address - Fax:
Practice Address - Street 1:1233 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0127
Practice Address - Country:US
Practice Address - Phone:406-237-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist