Provider Demographics
NPI:1194558700
Name:SEAHOLM, KAITLYN MARIE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:SEAHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 SPRAGUE HILL RD
Mailing Address - Street 2:
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-9753
Mailing Address - Country:US
Mailing Address - Phone:716-720-3064
Mailing Address - Fax:
Practice Address - Street 1:5536 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9746
Practice Address - Country:US
Practice Address - Phone:585-268-5681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist