Kaitlyn Elizabeth Brandow
Individual provider Active NPI Speech-Language Pathologist · Lindenhurst, NY
NPI 1184306995 · NPPES record last updated Aug 1, 2023
Key facts
- NPI
- 1184306995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 714 S 8TH St
Lindenhurst, NY 11757-5521 - Phone
- (631) 624-6755
- NPI assigned
- Aug 1, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3 Grace Ave
Suite 119
Great Neck, NY 11021-2400
381 Massapequa Ave
Massapequa, NY 11758-5219
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260204003024 | NY | Practitioner - Qualified Speech Language Pathologist | 3072092626 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034412 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Speak Your Legacy Inc. | Current |
Accepting new patients | |
| Speak Your Legacy Inc. | Speech-Language Pathologist | Current |
Accepting new patients |
| Outreach Physical and Occupational Therapy & Speech Rehabilitation, PLLC | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
3 Grace Ave
Ste 119
Great Neck, NY 11021
Phone (212) 842-0080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | NY | Yes |
Addresses
Primary practice location
714 S 8TH St
Lindenhurst, NY 11757-5521
Mailing address
381 Massapequa Ave
Massapequa, NY 11758-5219
Phone (516) 680-0876
Other providers in Lindenhurst, NY
- Rachel Leah Boyd
- Melissa Brancale
- Danielle Catalina Branciforti
- Brandon Spahn Physical Therapy PLLC
- Brandon Spahn PT PLLC
- Adam Bricca
- Dorith Brodbar
- Susan Brownstein
- Megan Jean Bryan
- Paul J Buchalter
All providers in Lindenhurst, NY · Speech-Language Pathologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.