Provider Demographics
NPI:1194989301
Name:KAISER, KATRINA M
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:KAISER
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 1:315 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4456
Mailing Address - Country:US
Mailing Address - Phone:352-795-7006
Mailing Address - Fax:352-795-7008
Practice Address - Street 1:297 N BROAD ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2925
Practice Address - Country:US
Practice Address - Phone:352-796-0069
Practice Address - Fax:352-796-0069
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist