MEDICARE: KYLIE A ABBOTT SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL012298	PA

General Provider Information

NPI Number	:	1477943538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE A ABBOTT SLP

Provider Business Mailing Address
First Line	:	95 JOHN ST APT A
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-3856
Country	:	US
Telephone Number	:	570-328-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 JOHN ST APT A
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-3856
Country	:	US
Telephone Number	:	570-328-4219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	03/05/2017

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Directions to “ KYLIE A ABBOTT SLP” Practice Location

Language	Start Address	Practice Location

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