Provider Demographics
NPI:1841077914
Name:ALEXANDER, KAITLIN REBECCA LAN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:REBECCA LAN
Last Name:ALEXANDER
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 1:10 WINDSOR PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:AR
Mailing Address - Zip Code:72176
Mailing Address - Country:US
Mailing Address - Phone:859-815-5044
Mailing Address - Fax:
Practice Address - Street 1:602 N LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:CABOOT
Practice Address - State:AR
Practice Address - Zip Code:72023
Practice Address - Country:US
Practice Address - Phone:501-843-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14398689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist