Provider Demographics
NPI:1164950846
Name:HINNENKAMP, KATIE ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:HINNENKAMP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:GREGOIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3175 SIENNA DR S
Mailing Address - Street 2:STE 103
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8910
Mailing Address - Country:US
Mailing Address - Phone:701-532-1906
Mailing Address - Fax:701-532-1896
Practice Address - Street 1:3175 SIENNA DR S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8910
Practice Address - Country:US
Practice Address - Phone:701-532-1906
Practice Address - Fax:701-532-1896
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1569OtherNORTH DAKOTA SLP LICENSE
MN9892OtherMN SLP LICENSE