Provider Demographics
NPI:1619549821
Name:DAILEY, KATELYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:DAILEY
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 1:108 REVERE RD APT 5
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-2126
Mailing Address - Country:US
Mailing Address - Phone:856-577-3870
Mailing Address - Fax:
Practice Address - Street 1:108 REVERE RD APT 5
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-2126
Practice Address - Country:US
Practice Address - Phone:856-577-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014926235Z00000X
NJ41YS01060100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist