Provider Demographics
NPI:1003076860
Name:TIERNEY, KATIE MEGAN (MS SLP-CFY)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MEGAN
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:MS SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10241 SE 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5208
Mailing Address - Country:US
Mailing Address - Phone:502-541-4090
Mailing Address - Fax:
Practice Address - Street 1:650 SE OAK ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4120
Practice Address - Country:US
Practice Address - Phone:503-648-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist