MEDICARE: KYLEN WHITMORE CCC-SLP

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	07917	MD

General Provider Information

NPI Number	:	1487202115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEN WHITMORE CCC-SLP

Provider Business Mailing Address
First Line	:	850 HUNGERFORD DR
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-1718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BRIGGS CHANEY RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-5503
Country	:	US
Telephone Number	:	301-989-5770
Fax Number	:

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

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	08/27/2019

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Directions to “ KYLEN WHITMORE CCC-SLP” Practice Location

Language	Start Address	Practice Location

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