Provider Demographics
NPI:1740097344
Name:ENRIQUEZ, KYLYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KYLYNN
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
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 1:9650 KENWORTHY ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-6011
Mailing Address - Country:US
Mailing Address - Phone:915-751-0967
Mailing Address - Fax:
Practice Address - Street 1:9650 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6011
Practice Address - Country:US
Practice Address - Phone:915-751-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist