Provider Demographics
NPI:1992489744
Name:CRAIG, KYLIE (MS, CCC- SLP TSSLD)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MS, CCC- SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BALAUREL DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4303
Mailing Address - Country:US
Mailing Address - Phone:203-687-7457
Mailing Address - Fax:
Practice Address - Street 1:101 SUMMER ST UNIT 504
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2324
Practice Address - Country:US
Practice Address - Phone:203-687-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18.007128-TEMP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist