Provider Demographics
NPI:1538505383
Name:WASGATT, KATELYN MARIE CLAIRE (CCC-A)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE CLAIRE
Last Name:WASGATT
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-368-3103
Mailing Address - Fax:508-368-3104
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3103
Practice Address - Fax:508-368-3104
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-1009-AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist