Provider Demographics
NPI:1558038984
Name:ROELLE, KATELYN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:ROELLE
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 1:301 W POWELL ST
Mailing Address - Street 2:
Mailing Address - City:HAXTUN
Mailing Address - State:CO
Mailing Address - Zip Code:80731-2654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:PEETZ
Practice Address - State:CO
Practice Address - Zip Code:80747-5000
Practice Address - Country:US
Practice Address - Phone:970-334-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist