Provider Demographics
NPI:1619516762
Name:IKARD, KAITLIN VICTORIA (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:VICTORIA
Last Name:IKARD
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 SLEEPY LN
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35776-6921
Mailing Address - Country:US
Mailing Address - Phone:931-308-3368
Mailing Address - Fax:
Practice Address - Street 1:305 W PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4360
Practice Address - Country:US
Practice Address - Phone:256-609-6946
Practice Address - Fax:256-912-0460
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14306946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist