Healthcare Provider Details

I. General information

NPI: 1629419874
Provider Name (Legal Business Name): PAULA WYLIE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 CEDAR RD
CHESTERLAND OH
44026-3519
US

IV. Provider business mailing address

8615 CEDAR RD
CHESTERLAND OH
44026-3519
US

V. Phone/Fax

Practice location:
  • Phone: 440-729-5900
  • Fax:
Mailing address:
  • Phone: 440-665-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4852
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP12016
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: