Provider Demographics
NPI:1083413629
Name:KRENTZIN, KYLIE (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:KRENTZIN
Suffix:
Gender:
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5501
Mailing Address - Country:US
Mailing Address - Phone:248-544-0360
Mailing Address - Fax:248-544-0388
Practice Address - Street 1:1742 CROOKS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5501
Practice Address - Country:US
Practice Address - Phone:248-544-0360
Practice Address - Fax:248-544-0388
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist