Doctor Name: | CAITLYN MARIE MCKIBBEN |
NPI Number: | 1376808311 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 8605 Centreville Rd Manassas, VA - 201105265 |
Business Phone Number: | 7032576242 |
Business Fax Number: | |
Mailing Address: | 1710 Lake Ave, SHADY SIDE |
State: | MD |
Postal Code: | 207649760 |
Phone Number: | 4436241202 |
Fax Number: | |
NPI Enumeration Date: | 07/05/2012 |
NPI Last Update Date: | 07/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |