Provider Demographics
NPI:1073156451
Name:HOAG, KAITLYN MIDDLE (MS)
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:MIDDLE
Last Name:HOAG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9305
Mailing Address - Country:US
Mailing Address - Phone:585-797-4633
Mailing Address - Fax:
Practice Address - Street 1:160 WALLACE WAY BLDG 9
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6215
Practice Address - Country:US
Practice Address - Phone:585-617-2300
Practice Address - Fax:585-349-8897
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029247Medicaid