Provider Demographics
NPI:1508661711
Name:VANNOORD, KAITLYN NICHOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:NICHOLE
Last Name:VANNOORD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:N
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4202 SUNBURST AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2398
Mailing Address - Country:US
Mailing Address - Phone:248-802-6293
Mailing Address - Fax:
Practice Address - Street 1:9100 LAPEER RD STE C
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-3620
Practice Address - Country:US
Practice Address - Phone:810-412-4183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist