Healthcare Provider Details

I. General information

NPI: 1376426155
Provider Name (Legal Business Name): KAITLYN MINNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BERKLEY DR
NEW ORLEANS LA
70131-7204
US

IV. Provider business mailing address

3617 ASPEN DR
HARVEY LA
70058-5837
US

V. Phone/Fax

Practice location:
  • Phone: 504-373-6281
  • Fax:
Mailing address:
  • Phone: 504-265-5127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9857
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: