Provider Demographics
NPI:1548023559
Name:COOK, KYLA EVELYN (CF SLP)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:EVELYN
Last Name:COOK
Suffix:
Gender:F
Credentials:CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 AVENIDA LA BARRANCA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4823
Mailing Address - Country:US
Mailing Address - Phone:907-854-9679
Mailing Address - Fax:
Practice Address - Street 1:4811 HARDWARE DR NE # 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2017
Practice Address - Country:US
Practice Address - Phone:505-268-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2024-0020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist