Provider Demographics
NPI:1851709794
Name:HERNANDEZ, KAITLIN
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:HERNANDEZ
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 1:235 W 48TH ST
Mailing Address - Street 2:APT. 39B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1404
Mailing Address - Country:US
Mailing Address - Phone:504-339-5108
Mailing Address - Fax:
Practice Address - Street 1:235 W 48TH ST
Practice Address - Street 2:APT. 39B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1404
Practice Address - Country:US
Practice Address - Phone:504-339-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist