Provider Demographics
NPI:1508614041
Name:BREINING, KYLIE (CFY-SLP)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:BREINING
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W LAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6813
Mailing Address - Country:US
Mailing Address - Phone:989-685-2664
Mailing Address - Fax:
Practice Address - Street 1:706 PINEYWOOD RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2753
Practice Address - Country:US
Practice Address - Phone:133-647-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist