Provider Demographics
NPI:1881771855
Name:KITTLE, VONDA L (MA)
Entity type:Individual
Prefix:MRS
First Name:VONDA
Middle Name:L
Last Name:KITTLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 SHAW AVE
Mailing Address - Street 2:SUITE 104, PMB 106
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3932
Mailing Address - Country:US
Mailing Address - Phone:559-287-9075
Mailing Address - Fax:
Practice Address - Street 1:1175 SHAW AVE
Practice Address - Street 2:SUITE 104, PMB 106
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3932
Practice Address - Country:US
Practice Address - Phone:559-287-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2005231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU2005OtherPROVIDER ID