Provider Demographics
NPI:1619322997
Name:DAMICH, KATHERINE MICHELLE (MA, CFY/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:DAMICH
Suffix:
Gender:F
Credentials:MA, CFY/SLP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:MICHELLE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CFY/SLP
Mailing Address - Street 1:1300 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1515
Mailing Address - Country:US
Mailing Address - Phone:517-294-0737
Mailing Address - Fax:
Practice Address - Street 1:151 2ND ST
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9647
Practice Address - Country:US
Practice Address - Phone:517-750-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist