Provider Demographics
NPI:1437593225
Name:SHRUM, KAITLYN KLUDJIAN (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:KLUDJIAN
Last Name:SHRUM
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:ALEXIS
Other - Last Name:KLUDJIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1389 WEBER INDUSTRIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:770-886-6204
Mailing Address - Fax:
Practice Address - Street 1:6867 SOUTHPOINT DR. N
Practice Address - Street 2:SUITE 106
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-619-6071
Practice Address - Fax:904-212-0304
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12172235Z00000X
MA8739235Z00000X
NH1460235Z00000X
GASLP009137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist