Provider Demographics
NPI:1679121628
Name:STILWELL, KATI LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:KATI
Middle Name:LYNN
Last Name:STILWELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATI
Other - Middle Name:LYNN
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47072 STATE HIGHWAY M26
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC MINE
Mailing Address - State:MI
Mailing Address - Zip Code:49905-9011
Mailing Address - Country:US
Mailing Address - Phone:810-348-2394
Mailing Address - Fax:
Practice Address - Street 1:901 W SHARON AVE STE 9
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1964
Practice Address - Country:US
Practice Address - Phone:906-523-7120
Practice Address - Fax:906-523-7122
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000856231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist