Provider Demographics
NPI:1700316981
Name:ATKINSON, KAITLIN NICOLE
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:NICOLE
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2314 PALOMINO PL
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6514
Mailing Address - Country:US
Mailing Address - Phone:618-694-7295
Mailing Address - Fax:
Practice Address - Street 1:2314 PALOMINO PL
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6514
Practice Address - Country:US
Practice Address - Phone:618-694-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist