Provider Demographics
NPI:1205268950
Name:ABDALLA, KAITLYN E
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:E
Last Name:ABDALLA
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 1:4301 S PINE ST STE 219
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7205
Mailing Address - Country:US
Mailing Address - Phone:253-476-6550
Mailing Address - Fax:253-476-6551
Practice Address - Street 1:109 S FESTIVAL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5801
Practice Address - Country:US
Practice Address - Phone:915-842-1788
Practice Address - Fax:915-842-1778
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC5357235Z00000X
WALL60488491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist