Healthcare Provider Details

I. General information

NPI: 1023971967
Provider Name (Legal Business Name): KYLEE PARKER CCC - SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 PORTLAND RD
SACO ME
04072-9673
US

IV. Provider business mailing address

895 PORTLAND RD
SACO ME
04072-9673
US

V. Phone/Fax

Practice location:
  • Phone: 207-439-5104
  • Fax: 207-571-8134
Mailing address:
  • Phone: 207-439-5104
  • Fax: 207-571-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberST4282
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: