Provider Demographics
NPI:1740825306
Name:GANTWERKER, KAITLYN ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:GANTWERKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5159
Mailing Address - Country:US
Mailing Address - Phone:631-848-1217
Mailing Address - Fax:
Practice Address - Street 1:430 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:718-470-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001711231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist