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General NPI Number Information
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NPI Number | 1790331429
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Entity Type | Individual
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Provider Name | KYLEE RAE DEAL MA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 2026 STATE ROUTE 45
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City | AUSTINBURG
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State | OH
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Zip | 44010-9711
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Country | US
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Telephone | 440-275-3019
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Fax |
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Provider Business Mailing Address
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Address Line | 351 JEFFERSON ST
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City | MEADVILLE
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State | PA
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Zip | 16335-1429
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Country | US
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Telephone | 814-541-4848
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | COND.20191107-SP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP.14007
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License Number State | OH
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