Provider Demographics
NPI:1356909758
Name:KURZHAL, KAITLYN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KURZHAL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46616-1950
Mailing Address - Country:US
Mailing Address - Phone:574-229-5645
Mailing Address - Fax:
Practice Address - Street 1:150 W ANGELA BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1101
Practice Address - Country:US
Practice Address - Phone:574-213-5080
Practice Address - Fax:833-315-2429
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14255177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN14255177OtherINDIANA PROFESSIONAL LICENSING AGENCY