Provider Demographics
NPI:1013202183
Name:HURLEY, KAITLIN MICHELLE (MA CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MICHELLE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BLACKWATCH TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3724
Mailing Address - Country:US
Mailing Address - Phone:585-421-8082
Mailing Address - Fax:
Practice Address - Street 1:58 BLACKWATCH TRL
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3724
Practice Address - Country:US
Practice Address - Phone:585-421-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019280-1235Z00000X
TN4992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist