Healthcare Provider Details

I. General information

NPI: 1114854429
Provider Name (Legal Business Name): KAITLYN GOULET M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 WILLARD ST W
STILLWATER MN
55082-5553
US

IV. Provider business mailing address

2003 WILLARD ST W
STILLWATER MN
55082-5553
US

V. Phone/Fax

Practice location:
  • Phone: 651-351-6864
  • Fax:
Mailing address:
  • Phone: 651-351-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14382457
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: