Provider Demographics
NPI:1801636063
Name:BEAN, KAITLYN (CF-SLP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BEAN
Suffix:
Gender:
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 LEGAULT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9427
Mailing Address - Country:US
Mailing Address - Phone:248-672-2516
Mailing Address - Fax:
Practice Address - Street 1:1100 W NEWARK RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-9449
Practice Address - Country:US
Practice Address - Phone:810-358-0373
Practice Address - Fax:810-660-8158
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101009379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist