Provider Demographics
NPI:1528707502
Name:FARID, KAITLYN WILLS (AUD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:WILLS
Last Name:FARID
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5508 WATERSIDE LOOP APT 104
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-9651
Mailing Address - Country:US
Mailing Address - Phone:205-834-3667
Mailing Address - Fax:
Practice Address - Street 1:3020 LAKELAND HIGHLANDS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4338
Practice Address - Country:US
Practice Address - Phone:863-686-3189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2581231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist