Provider Demographics
NPI:1346409281
Name:FELTON, KATHERINE CAROLYN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:CAROLYN
Last Name:FELTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5209
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5209
Mailing Address - Country:US
Mailing Address - Phone:865-982-3400
Mailing Address - Fax:865-982-3410
Practice Address - Street 1:2030 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5285
Practice Address - Country:US
Practice Address - Phone:865-982-3400
Practice Address - Fax:865-982-3410
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516788Medicaid