Most Relevant Information
Provider Data
| NPI Number: | 1003534116 |
| Provider Name: | KYLIE FARISON |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/16/2022 |
| Last Updated: | 08/18/2022 |
Provider Practice Location
1621 ANDREA DR
NEW LENOX
IL
604512303
Practice Location Phone/Fax
| Phone: | 7794350724 |
| Fax: |
Provider Mailing Location
PO BOX 405
NEW LENOX
IL
604510405
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |