MEDICARE: MRS. KAITLIN MARTHA MIHALICK AUDIOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	2201001650	VA

General Provider Information

NPI Number	:	1417484551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAITLIN MARTHA MIHALICK AUDIOLOGIST

Provider Business Mailing Address
First Line	:	500 INDEPENDENCE PARKWAY
Second Line	:	STE 100
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-5197
Country	:	US
Telephone Number	:	757-547-9714
Fax Number	:	757-547-0725

Provider Business Practice Location Address
First Line	:	1037 CHAMPIONS WAY
Second Line	:	STE 100
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3764
Country	:	US
Telephone Number	:	757-547-9714
Fax Number	:	757-547-0725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2017
Last Update Date	:	12/09/2022

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