Provider Demographics
NPI:1952100489
Name:CLARK, KYLEE BROOKE (MS-SLP)
Entity type:Individual
Prefix:MS
First Name:KYLEE
Middle Name:BROOKE
Last Name:CLARK
Suffix:
Gender:
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1501
Mailing Address - Country:US
Mailing Address - Phone:845-519-2295
Mailing Address - Fax:
Practice Address - Street 1:3631 HILL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1501
Practice Address - Country:US
Practice Address - Phone:845-519-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist