Provider Demographics
NPI:1164986642
Name:GOLLIN, KATLYN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:GOLLIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 STONESTHROW CIR N APT 9102
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4765
Mailing Address - Country:US
Mailing Address - Phone:248-568-1421
Mailing Address - Fax:
Practice Address - Street 1:6916 STONESTHROW CIR N APT 9102
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4765
Practice Address - Country:US
Practice Address - Phone:248-568-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist