Provider Demographics
NPI:1699288761
Name:COOLEY, KAITLIN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 KEMI LN
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1150
Mailing Address - Country:US
Mailing Address - Phone:631-707-2698
Mailing Address - Fax:
Practice Address - Street 1:35 KREAMER ST
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2337
Practice Address - Country:US
Practice Address - Phone:631-730-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist