Provider Demographics
NPI:1043989718
Name:TUELLER, KATIE RAE
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:RAE
Last Name:TUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 N LOTUS CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-4905
Mailing Address - Country:US
Mailing Address - Phone:480-334-5625
Mailing Address - Fax:
Practice Address - Street 1:1560 W SUMMIT PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1203
Practice Address - Country:US
Practice Address - Phone:480-472-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA131112355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant