Provider Demographics
NPI:1386392280
Name:SMITH, KAITLIN ALEXIS (BA SLPA)
Entity type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:ALEXIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14201 W SUNRISE BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-756-2818
Mailing Address - Fax:954-514-1126
Practice Address - Street 1:14201 W SUNRISE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-756-2818
Practice Address - Fax:954-514-1126
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI51852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI5185OtherDEPARTMENT OF HEALTH