Individual
MRS. TERESA MARIE KYLLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SP
Contact information
Practice address
711 17TH AVE W, WILLISTON, ND 58801-4529
(701) 572-0731
Mailing address
711 17TH AVE W, WILLISTON, ND 58801-4529
(701) 572-0731
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
442
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25555
BCBS PROVIDER ID NUMBER
ND
05
—
58528
—
ND
Enumeration date
09/17/2006
Last updated
07/08/2007
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