Provider Demographics
NPI:1235949033
Name:SLEDGE, KYLIE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:SLEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8393
Mailing Address - Country:US
Mailing Address - Phone:512-865-8964
Mailing Address - Fax:
Practice Address - Street 1:2305 LONGMIRE DR STE 300
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7034
Practice Address - Country:US
Practice Address - Phone:936-293-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist