MEDICARE: KAITLIN PODDAM

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	235Z00000X	Speech-Language Pathologist	7101006856	MI

General Provider Information

NPI Number	:	1861342396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN PODDAM

Provider Business Mailing Address
First Line	:	811 N MACOMB ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-2929
Country	:	US
Telephone Number	:	419-482-8647
Fax Number	:	734-597-2018

Provider Business Practice Location Address
First Line	:	811 N MACOMB ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-2929
Country	:	US
Telephone Number	:	419-482-8647
Fax Number	:	734-597-2018

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ KAITLIN PODDAM ” Practice Location

Language	Start Address	Practice Location

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