Provider Demographics
NPI:1356909519
Name:LOWERY, KAYLENE ROSE (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KAYLENE
Middle Name:ROSE
Last Name:LOWERY
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MISS
Other - First Name:KAYLENE
Other - Middle Name:ROSE
Other - Last Name:MESECHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2051 W CUMBERLAND RD APT 607
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7852
Mailing Address - Country:US
Mailing Address - Phone:713-459-8373
Mailing Address - Fax:
Practice Address - Street 1:3310 S BROADWAY AVE STE 100I
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7818
Practice Address - Country:US
Practice Address - Phone:903-780-3505
Practice Address - Fax:877-798-4959
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist