Provider Demographics
NPI:1356822720
Name:SMITH, KAITLIN MAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MAE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:14642 VINE ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7382
Mailing Address - Country:US
Mailing Address - Phone:507-273-7259
Mailing Address - Fax:
Practice Address - Street 1:1401 ELMHURST DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-2399
Practice Address - Country:US
Practice Address - Phone:303-772-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist