Provider Demographics
NPI:1598429094
Name:MCNABB, KAITLYN MARIE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:MARIE
Last Name:MCNABB
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4802
Mailing Address - Country:US
Mailing Address - Phone:203-915-9010
Mailing Address - Fax:
Practice Address - Street 1:467 S ELM ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4802
Practice Address - Country:US
Practice Address - Phone:203-915-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18.006354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist