Provider Demographics
NPI:1912317702
Name:GRABILL, KAITLYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:GRABILL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1559
Mailing Address - Country:US
Mailing Address - Phone:419-366-6025
Mailing Address - Fax:
Practice Address - Street 1:311 PORTLAND DR
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1559
Practice Address - Country:US
Practice Address - Phone:419-366-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 10729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist