Provider Demographics
NPI:1174277008
Name:KATELYNN HIGHTOWER SPEECH THERAPY
Entity Type:Organization
Organization Name:KATELYNN HIGHTOWER SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYNN
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:334-625-0121
Mailing Address - Street 1:1479 WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2013
Mailing Address - Country:US
Mailing Address - Phone:334-625-0121
Mailing Address - Fax:256-617-7235
Practice Address - Street 1:1479 WATSON AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2013
Practice Address - Country:US
Practice Address - Phone:334-625-0121
Practice Address - Fax:256-617-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10273328Medicaid