Provider Demographics
NPI:1447682844
Name:SCHRAG, KYLEA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KYLEA
Middle Name:
Last Name:SCHRAG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N SHERIDAN ST APT 24
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-6648
Mailing Address - Country:US
Mailing Address - Phone:316-650-9480
Mailing Address - Fax:
Practice Address - Street 1:1315 N SHERIDAN ST APT 24
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-6648
Practice Address - Country:US
Practice Address - Phone:316-650-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist