Provider Demographics
NPI:1568773216
Name:WALES, KATIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:WALES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-5022
Mailing Address - Country:US
Mailing Address - Phone:985-796-5548
Mailing Address - Fax:
Practice Address - Street 1:13700 HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-5022
Practice Address - Country:US
Practice Address - Phone:985-796-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist