Provider Demographics
NPI:1801623582
Name:WEIDENBENNER, KYLEE BETH (MA, SLP)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:BETH
Last Name:WEIDENBENNER
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 DELWIN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2377
Mailing Address - Country:US
Mailing Address - Phone:618-540-5892
Mailing Address - Fax:
Practice Address - Street 1:1910 WHITENER ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5239
Practice Address - Country:US
Practice Address - Phone:573-334-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist