Provider Demographics
NPI:1346802444
Name:ALLEN, KAITLIN ANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KAITLIN
Other - Middle Name:ANNE
Other - Last Name:KOPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6579 ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4925
Mailing Address - Country:US
Mailing Address - Phone:216-571-4308
Mailing Address - Fax:
Practice Address - Street 1:14713 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4943
Practice Address - Country:US
Practice Address - Phone:440-582-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSZ8667235Z00000X
OHSP.14278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist