Individual
KYLA VAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4586 S 116TH RD, BOLIVAR, MO 65613-8547
(417) 326-2466
(417) 326-7739
Mailing address
4586 S 116TH RD, BOLIVAR, MO 65613-8547
(417) 326-2466
(417) 326-7739
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2015021151
MO
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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