Provider Demographics
NPI:1336581909
Name:TITSWORTH, KAITLIN
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:TITSWORTH
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 1:14575 WEST MOUNTAIN VIEW BOULEVARD
Mailing Address - Street 2:#10313
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:217-710-4803
Mailing Address - Fax:
Practice Address - Street 1:2040 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 1, PMB 500
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7075
Practice Address - Country:US
Practice Address - Phone:602-323-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist