Healthcare Provider Details

I. General information

NPI: 1144157348
Provider Name (Legal Business Name): KYLA THRASHER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MILLSFORD CT
TYRONE GA
30290-1554
US

IV. Provider business mailing address

105 MILLSFORD CT
TYRONE GA
30290-1554
US

V. Phone/Fax

Practice location:
  • Phone: 913-683-8164
  • Fax:
Mailing address:
  • Phone: 913-683-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP012887
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: