Provider Demographics
NPI:1477022325
Name:ANDERLA, KAITLYN M (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:M
Last Name:ANDERLA
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 1:261 FRENCH STREET
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-9200
Mailing Address - Country:US
Mailing Address - Phone:715-582-2020
Mailing Address - Fax:715-582-0803
Practice Address - Street 1:701 WILLOW STREET
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-9200
Practice Address - Country:US
Practice Address - Phone:715-582-0144
Practice Address - Fax:715-582-0833
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4739-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist