Provider Demographics
NPI:1033391412
Name:DEBICKI, KATIE A (SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:DEBICKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:524 E MCKINLEY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-6285
Mailing Address - Country:US
Mailing Address - Phone:574-255-8730
Mailing Address - Fax:574-255-8732
Practice Address - Street 1:524 E MCKINLEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-255-8730
Practice Address - Fax:574-255-8732
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242000708235Z00000X
IN22004936A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300037606Medicaid