Provider Demographics
NPI:1649945148
Name:ZALOGA, KAITLYN ANNA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANNA
Last Name:ZALOGA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ANNA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1273
Mailing Address - Country:US
Mailing Address - Phone:570-362-2348
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1273
Practice Address - Country:US
Practice Address - Phone:570-362-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist