Healthcare Provider Details

I. General information

NPI: 1093160848
Provider Name (Legal Business Name): KAITLYN WHITE ROUSH M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N WASHINGTON AVE SUITE 5000
DALLAS TX
75246-1713
US

IV. Provider business mailing address

411 N WASHINGTON AVE SUITE 5000
DALLAS TX
75246-1713
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-9560
  • Fax:
Mailing address:
  • Phone: 214-820-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number111158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: