Provider Demographics
NPI:1255181566
Name:LEDUC, KAITLYN ROSE (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:LEDUC
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-0034
Mailing Address - Country:US
Mailing Address - Phone:952-292-1967
Mailing Address - Fax:952-443-9804
Practice Address - Street 1:1772 STIEGER LAKE LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7720
Practice Address - Country:US
Practice Address - Phone:952-292-1967
Practice Address - Fax:952-443-9804
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist