Healthcare Provider Details

I. General information

NPI: 1538091160
Provider Name (Legal Business Name): KYLE WESLEY POLZIN CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 364
DOBSON NC
27017-0364
US

IV. Provider business mailing address

1537 BEAR CREEK RD
RUSTBURG VA
24588-2873
US

V. Phone/Fax

Practice location:
  • Phone: 336-386-8211
  • Fax:
Mailing address:
  • Phone: 320-420-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: