Provider Demographics
NPI:1619453636
Name:JAENKE, KATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:JAENKE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:CAMERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3508 COMPTON PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4079
Mailing Address - Country:US
Mailing Address - Phone:484-274-4944
Mailing Address - Fax:
Practice Address - Street 1:3508 COMPTON PKWY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4079
Practice Address - Country:US
Practice Address - Phone:484-274-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014013235Z00000X
OHSP.13805235Z00000X
MO2020013061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist