Provider Demographics
NPI:1912465907
Name:PRANAV, KAITLIN NICOLE (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:NICOLE
Last Name:PRANAV
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:MISS
Other - First Name:KAITLIN
Other - Middle Name:NICOLE
Other - Last Name:DICRISTOFARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP, TSSLD
Mailing Address - Street 1:201 SUNRISE HWY W
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1868
Mailing Address - Country:US
Mailing Address - Phone:631-289-2200
Mailing Address - Fax:
Practice Address - Street 1:201 SUNRISE HWY W
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1868
Practice Address - Country:US
Practice Address - Phone:631-289-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist