Provider Demographics
NPI:1295228690
Name:WYCHE, KAITLYN E (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:E
Last Name:WYCHE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:LACO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2416 ELKHORN RANCH ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4229
Mailing Address - Country:US
Mailing Address - Phone:303-378-7813
Mailing Address - Fax:
Practice Address - Street 1:2416 ELKHORN RANCH ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-4229
Practice Address - Country:US
Practice Address - Phone:303-378-7813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0002450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty