Provider Demographics
NPI:1801494273
Name:SEABOURNE, KAITLIN B (SLP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:B
Last Name:SEABOURNE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-3580
Mailing Address - Country:US
Mailing Address - Phone:573-431-3300
Mailing Address - Fax:
Practice Address - Street 1:300 BERRY RD
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-3580
Practice Address - Country:US
Practice Address - Phone:573-431-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020025293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist