MEDICARE: KYLIE GAUGHAN M.S., CFY-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		KS

General Provider Information

NPI Number	:	1790136000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE GAUGHAN M.S., CFY-SLP

Provider Business Mailing Address
First Line	:	708 N MAIN ST
Second Line	:
City	:	ST JOHN
State	:	KS
Zip	:	67576-1534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 N SANTA FE ST
Second Line	:
City	:	ST JOHN
State	:	KS
Zip	:	67576-1800
Country	:	US
Telephone Number	:	620-549-3541
Fax Number	:

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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Directions to “ KYLIE GAUGHAN M.S., CFY-SLP” Practice Location

Language	Start Address	Practice Location

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