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General NPI Number Information
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NPI Number | 1356909519
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Entity Type | Individual
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Provider Name | KAYLENE ROSE LOWERY M.S. CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 3310 S BROADWAY AVE STE 100I
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City | TYLER
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State | TX
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Zip | 75701-7818
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Country | US
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Telephone | 903-780-3505
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Fax | 877-798-4959
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Provider Business Mailing Address
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Address Line | 2051 W CUMBERLAND RD APT 607
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City | TYLER
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State | TX
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Zip | 75703-7852
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Country | US
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Telephone | 713-459-8373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 115533
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License Number State | TX
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