Provider Demographics
NPI:1336540178
Name:IVES, KAITLYN (AUD)
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:
Last Name:IVES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:WERHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6553 E BAYWOOD AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1753
Mailing Address - Country:US
Mailing Address - Phone:602-956-1250
Mailing Address - Fax:623-321-8620
Practice Address - Street 1:1492 S MILL AVE STE 301
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5676
Practice Address - Country:US
Practice Address - Phone:480-894-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA9099231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ527862Medicaid