Provider Demographics
NPI:1548741853
Name:WERTH, KAITLIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WERTH
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 1:10120 DUNBARTON DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1271
Mailing Address - Country:US
Mailing Address - Phone:334-791-3562
Mailing Address - Fax:
Practice Address - Street 1:600 SAINT CLAIR AVE SW STE 14
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5057
Practice Address - Country:US
Practice Address - Phone:256-533-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist