Provider Demographics
NPI:1356004725
Name:PIETSCH, KATIE A
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:PIETSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 S QUEBEC WAY APT B22
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5623
Mailing Address - Country:US
Mailing Address - Phone:805-637-2047
Mailing Address - Fax:
Practice Address - Street 1:1885 S QUEBEC WAY APT B22
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5623
Practice Address - Country:US
Practice Address - Phone:805-637-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CO14288108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist