Provider Demographics
NPI:1558550723
Name:WOODBURNE, KATHERINE SUZANNE (AUD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:WOODBURNE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ROCKVIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9167
Mailing Address - Country:US
Mailing Address - Phone:616-863-9855
Mailing Address - Fax:
Practice Address - Street 1:51 ROCKVIEW DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9167
Practice Address - Country:US
Practice Address - Phone:616-863-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000226231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist