MEDICARE: RONDA C LYLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	101171	TX

General Provider Information

NPI Number	:	1356519888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDA C LYLES

Provider Business Mailing Address
First Line	:	611 W HIGHWAY 6 STE 115
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7545
Country	:	US
Telephone Number	:	254-399-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 W HIGHWAY 6 STE 115
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7545
Country	:	US
Telephone Number	:	254-399-8255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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Directions to “ RONDA C LYLES ” Practice Location

Language	Start Address	Practice Location

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