Provider Demographics
NPI:1407570088
Name:WAY, KATHERINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 MAPLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MADEIRA
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1322
Mailing Address - Country:US
Mailing Address - Phone:651-395-9069
Mailing Address - Fax:
Practice Address - Street 1:5670 MAPLERIDGE DR
Practice Address - Street 2:
Practice Address - City:MADEIRA
Practice Address - State:OH
Practice Address - Zip Code:45227-1322
Practice Address - Country:US
Practice Address - Phone:651-395-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist