Provider Demographics
NPI:1235491077
Name:VIENOT, KATIE J (MA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:VIENOT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 LEE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4525
Mailing Address - Country:US
Mailing Address - Phone:316-617-3928
Mailing Address - Fax:
Practice Address - Street 1:507 LEE ST APT 2
Practice Address - Street 2:SUITE 200
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4525
Practice Address - Country:US
Practice Address - Phone:847-969-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4047235Z00000X
IL146-03166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist