Healthcare Provider Details

I. General information

NPI: 1841120193
Provider Name (Legal Business Name): KAITLYN VICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 PROVIDENCE RD
CHESAPEAKE VA
23325-4603
US

IV. Provider business mailing address

6304 EASTPORT RD
VIRGINIA BEACH VA
23464-1804
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0153
  • Fax:
Mailing address:
  • Phone: 757-793-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22404001537
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: