Healthcare Provider Details

I. General information

NPI: 1114836673
Provider Name (Legal Business Name): KAITLYN ROSE SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODMONT RD
JOHNSTOWN PA
15905-1342
US

IV. Provider business mailing address

457 MAPLE AVE
BLAIRSVILLE PA
15717-1033
US

V. Phone/Fax

Practice location:
  • Phone: 814-255-1488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSL003394
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: