Provider Demographics
NPI:1245776103
Name:AYRES, KAITLYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:
Last Name:AYRES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2054
Mailing Address - Country:US
Mailing Address - Phone:734-764-8440
Mailing Address - Fax:734-647-2489
Practice Address - Street 1:1111 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2054
Practice Address - Country:US
Practice Address - Phone:734-764-8440
Practice Address - Fax:734-647-2489
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1497772396OtherUCLL