Individual
KAITLIN SHANAHAN FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
768 N TANEY ST, PHILADELPHIA, PA 19130-2418
(610) 675-7734
Mailing address
768 N TANEY ST, PHILADELPHIA, PA 19130-2418
(610) 675-7734
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
77218-SP-SL
MA
235Z00000X
Speech-Language Pathologist
Primary
SL015152
PA
Other
Enumeration date
12/09/2020
Last updated
12/09/2020
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