Provider Demographics
NPI:1326791542
Name:MILITO, KAELEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAELEIGH
Middle Name:
Last Name:MILITO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MILITO WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2989
Mailing Address - Country:US
Mailing Address - Phone:908-217-9565
Mailing Address - Fax:
Practice Address - Street 1:151 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2813
Practice Address - Country:US
Practice Address - Phone:908-217-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14313234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3HZN48320610OtherHORIZON
NJNJX3HZN48320610OtherHORIZON