Provider Demographics
NPI:1780452250
Name:STANLEY, KAITLYN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50700 HAVEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9732
Mailing Address - Country:US
Mailing Address - Phone:574-276-7718
Mailing Address - Fax:
Practice Address - Street 1:50700 HAVEN HILL DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9732
Practice Address - Country:US
Practice Address - Phone:574-276-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007992A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist