Provider Demographics
NPI:1447624135
Name:YETTER, KYLEE (MA)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:YETTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 JAMESTOWN ST
Mailing Address - Street 2:APT 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1727
Mailing Address - Country:US
Mailing Address - Phone:570-898-5634
Mailing Address - Fax:
Practice Address - Street 1:575 JAMESTOWN ST
Practice Address - Street 2:APT 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1727
Practice Address - Country:US
Practice Address - Phone:570-898-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist