Provider Demographics
NPI:1114599727
Name:HALE, KAITLYN (SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150C HOBBS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-6008
Mailing Address - Country:US
Mailing Address - Phone:251-404-2267
Mailing Address - Fax:
Practice Address - Street 1:220 9TH ST
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1924
Practice Address - Country:US
Practice Address - Phone:850-229-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist