Provider Demographics
NPI:1639482623
Name:SCALES, KATY ELIZABETH (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:ELIZABETH
Last Name:SCALES
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-2135
Mailing Address - Country:US
Mailing Address - Phone:812-217-6295
Mailing Address - Fax:
Practice Address - Street 1:605 STATE ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-1299
Practice Address - Country:US
Practice Address - Phone:812-217-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005103A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist