Provider Demographics
NPI:1700268919
Name:WOOTEN, KAITLYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYNN
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:KAITLYNN
Other - Middle Name:
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2515 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1510 S CONWELL AVE
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9448
Practice Address - Country:US
Practice Address - Phone:419-964-5700
Practice Address - Fax:419-933-7822
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2015234-SP235Z00000X
OHSP.12063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist