Provider Demographics
NPI:1376089029
Name:REILLY, KATELYN
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:REILLY
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 1:1215 21ST AVE S STE 9302MCE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-8025
Mailing Address - Country:US
Mailing Address - Phone:561-593-6507
Mailing Address - Fax:
Practice Address - Street 1:1215 21ST AVE S STE 9302MCE
Practice Address - Street 2:SOUTH TOWER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-8025
Practice Address - Country:US
Practice Address - Phone:561-593-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1717231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist