Provider Demographics
NPI:1174716112
Name:PYLE, KELLY LYNN (MS CCC/SLP-L)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:PYLE
Suffix:
Gender:F
Credentials:MS CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-9725
Mailing Address - Country:US
Mailing Address - Phone:724-331-8301
Mailing Address - Fax:
Practice Address - Street 1:827 GEORGES STATION RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6457
Practice Address - Country:US
Practice Address - Phone:724-837-7100
Practice Address - Fax:724-837-7102
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007726730009Medicaid