Provider Demographics
NPI:1629755913
Name:GALLAGHER, KAITLYN MARIE (MED, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MED, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 LORI LN
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-0829
Mailing Address - Country:US
Mailing Address - Phone:706-400-0160
Mailing Address - Fax:
Practice Address - Street 1:8703 HIGHWAY 17 BYP S # 1
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-7701
Practice Address - Country:US
Practice Address - Phone:843-457-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist