Provider Demographics
NPI:1821753518
Name:DISKIN, KAITLIN
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:DISKIN
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 1:336 WITHERBEE RD
Mailing Address - Street 2:
Mailing Address - City:WITHERBEE
Mailing Address - State:NY
Mailing Address - Zip Code:12998-1681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3092 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:MINEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12956
Practice Address - Country:US
Practice Address - Phone:518-942-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031160-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist