Provider Demographics
NPI:1306381975
Name:BECKETT, KATLYN ROSE (MS SLP-CFY)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ROSE
Last Name:BECKETT
Suffix:
Gender:F
Credentials:MS SLP-CFY
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:ROSE
Other - Last Name:BECKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76 RICHARDS AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5453
Mailing Address - Country:US
Mailing Address - Phone:616-666-0551
Mailing Address - Fax:
Practice Address - Street 1:2251 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2431
Practice Address - Country:US
Practice Address - Phone:616-447-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist