Provider Demographics
NPI:1477980985
Name:MARGARIDA, KATELYN ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:ANN
Last Name:MARGARIDA
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 1:75 POCASSET ST
Mailing Address - Street 2:UNIT 221
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-6900
Mailing Address - Country:US
Mailing Address - Phone:401-714-1064
Mailing Address - Fax:
Practice Address - Street 1:2080 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0247
Practice Address - Country:US
Practice Address - Phone:401-714-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-28
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101001719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist