Healthcare Provider Details

I. General information

NPI: 1881079085
Provider Name (Legal Business Name): KYLENE COSAND CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYLENE SHOLTZ SLP

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 CIMARRON PLZ SUITE 105
HASTINGS NE
68901-2884
US

IV. Provider business mailing address

1144 COUNTY 693 AVE
DOWNS KS
67437-9048
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-2077
  • Fax: 402-463-2062
Mailing address:
  • Phone: 785-545-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: