Provider Demographics
NPI:1447681770
Name:EPPS, KYLE DENVER
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DENVER
Last Name:EPPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:DENVER
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:8120 NORTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4930
Mailing Address - Country:US
Mailing Address - Phone:661-345-2172
Mailing Address - Fax:
Practice Address - Street 1:34 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:CO
Practice Address - Zip Code:80466
Practice Address - Country:US
Practice Address - Phone:303-258-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist