Provider Demographics
NPI:1942860499
Name:BYRNSIDE, KAITLYN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BYRNSIDE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:BRYNSIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1506 SAINT JOHN AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5246
Mailing Address - Country:US
Mailing Address - Phone:318-376-0028
Mailing Address - Fax:
Practice Address - Street 1:1605 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5629
Practice Address - Country:US
Practice Address - Phone:318-388-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist