Basic Information
| Provider Information | |||||||||
| NPI: | 1255075420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOEWLER | ||||||||
| FirstName: | KAITLYN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2675 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280541478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048247800 | ||||||||
| FaxNumber: | 7048242822 | ||||||||
| Practice Location | |||||||||
| Address1: | 16409 NORTHCROSS DR | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280785065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804418200 | ||||||||
| FaxNumber: | 9804418202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2022 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 30000546 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.