Provider Demographics
NPI:1568628162
Name:SHEA, KATHERINE C (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:C
Last Name:SHEA
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 BERTHA DR
Mailing Address - Street 2:6417 BERTHA DRIVE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2247
Mailing Address - Country:US
Mailing Address - Phone:504-288-4318
Mailing Address - Fax:
Practice Address - Street 1:6417 BERTHA DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-2247
Practice Address - Country:US
Practice Address - Phone:504-288-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist