Provider Demographics
NPI:1356652069
Name:KING, KATIE LYNNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNNE
Last Name:KING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CASCADILLA ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4405
Mailing Address - Country:US
Mailing Address - Phone:919-414-0460
Mailing Address - Fax:
Practice Address - Street 1:2501 CASCADILLA ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4405
Practice Address - Country:US
Practice Address - Phone:919-414-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist