Provider Demographics
NPI:1639444706
Name:WADE, KAITLYN ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:ANN
Last Name:WADE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:ANN
Other - Last Name:HILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:103 NIGHTHAWK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1499
Mailing Address - Country:US
Mailing Address - Phone:631-335-5730
Mailing Address - Fax:
Practice Address - Street 1:508 AUTUMN SPRINGS CT STE 1A
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8274
Practice Address - Country:US
Practice Address - Phone:615-614-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist