Kylie Lyn Servello, MS, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.014705 Issued in IL

Practice address

400 Webber Rd
Spartanburg, SC 29307-2400

Phone

(864) 579-7004

NPI assigned

Aug 30, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1679055297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 OLD HOWELL RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296151969",
            "telephone_number": "864-244-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WEBBER RD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293072400",
            "telephone_number": "864-579-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERVELLO",
        "first_name": "KYLIE",
        "middle_name": "LYN",
        "credential": "MS, SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-30",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.014705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS PROFESSIONAL LICENSE",
            "identifier": "146.014705",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING, AND REGULATION",
            "identifier": "7281",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Serenity Psychotherapy
• Peter Arnold Sereque, M.D.
• Rachel Setzer, M.A., CCC-SLP
• Melissa Ann Seward, PT, DPT
• Laura Ruth Sexton, M.S.
• Victoria Shadiack
• Anand Pinakin Shah, MD

• Speech-Language Pathologist in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.