NPIMap

Kaitlyn L Black, M.A. CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Bonita Springs, FL

NPI 1669980785 · NPPES record last updated Apr 12, 2022

Key facts

NPI
1669980785
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SA16873 (FL)
Practice address
27221 Bay Landing Dr
Bonita Springs, FL 34135-4355
Phone
(239) 319-4601
NPI assigned
Jan 11, 2018
Sex
Female
Sole proprietor
Yes

Organizations & group practices 25

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare Care Compare profile

Specialty
Qualified Speech Language Pathologist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthpro Heritage Rehab and Fitness LLC (976 clinicians)
Ippolito Rehabilitation LLC (16 clinicians)

Practice addresses (Care Compare)

27221 Bay Landing Dr
Bonita Springs, FL 34135-4355
Phone (239) 296-2750

3569 Pilot Cir
Naples, FL 34120-0714
Phone (239) 390-3978

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20220428002305 FL Practitioner - Qualified Speech Language Pathologist 3577950138 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
SA16873FLMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ippolito Rehabilitation, LLC Current
since Jan 7, 2026		 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist Current
since Mar 25, 2022		 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist Current
since Mar 25, 2022		 Accepting new patients

Locations

27221 Bay Landing Dr
Bonita Springs, FL 34135
Phone (239) 296-2750

12840 Tamiami Trl N
Ste 200
Naples, FL 34110
Phone (239) 390-3978

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA16873 FL Yes

Addresses

Primary practice location

27221 Bay Landing Dr
Bonita Springs, FL 34135-4355

Mailing address

2103 Lake Baldwin Lane Box 229
Orlando, FL 32814

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 12, 2022.

{
    "created_epoch": "1515628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1669980785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 LAKE BALDWIN LANE BOX 229",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27221 BAY LANDING DR",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354355",
            "telephone_number": "239-319-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KAITLYN",
        "middle_name": "L",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-11",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA16873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

All providers in Bonita Springs, FL · Speech-Language Pathologist in Florida

Sources for this page

Verify at the official NPI Registry.