MEDICARE: KAYTLYNN DIANE THOMPSON CCC-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	2025036319	MO

General Provider Information

NPI Number	:	1598696718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYTLYNN DIANE THOMPSON CCC-SLP

Provider Business Mailing Address
First Line	:	138 ALISHA AVE
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-8385
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 ALISHA AVE
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-8385
Country	:	US
Telephone Number	:	573-429-9719
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ KAYTLYNN DIANE THOMPSON CCC-SLP” Practice Location

Language	Start Address	Practice Location

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