Provider Demographics
NPI:1275251019
Name:DAVENPORT, KYLIE ALLMAN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:ALLMAN
Last Name:DAVENPORT
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 NORTHSHORE TRL
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0077
Mailing Address - Country:US
Mailing Address - Phone:210-412-0229
Mailing Address - Fax:
Practice Address - Street 1:6111 FOX CREEK ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1154
Practice Address - Country:US
Practice Address - Phone:210-407-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist