Provider Demographics
NPI:1619592219
Name:GUTIERREZ, KAITLYNN ANNE
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:ANNE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 14TH ST NW APT 705
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-7609
Mailing Address - Country:US
Mailing Address - Phone:786-327-2697
Mailing Address - Fax:
Practice Address - Street 1:4883 HWY 47
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-3606
Practice Address - Country:US
Practice Address - Phone:561-994-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty