Provider Demographics
NPI:1366042509
Name:WALSH, KAITLIN NICOLE (AUD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:NICOLE
Other - Last Name:NEWVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:598 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1033
Mailing Address - Country:US
Mailing Address - Phone:608-833-8484
Mailing Address - Fax:
Practice Address - Street 1:120 PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2132
Practice Address - Country:US
Practice Address - Phone:920-885-5225
Practice Address - Fax:920-356-6419
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI716156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist