Provider Demographics
NPI:1528607264
Name:THOMPSON, KATRINA KAY (SLPA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 E FLORIAN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2798
Mailing Address - Country:US
Mailing Address - Phone:480-528-2746
Mailing Address - Fax:
Practice Address - Street 1:4309 E FLORIAN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2798
Practice Address - Country:US
Practice Address - Phone:480-528-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA121992355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant