Provider Demographics
NPI:1528413481
Name:KLUMPP, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KLUMPP
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 1:6701 SANGER AVE
Mailing Address - Street 2:#103
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 SANGER AVE
Practice Address - Street 2:#103
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7736
Practice Address - Country:US
Practice Address - Phone:254-399-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist