Provider Demographics
NPI:1689138737
Name:DRUCK, KATIE L
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:L
Last Name:DRUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BORG RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-8205
Mailing Address - Country:US
Mailing Address - Phone:814-321-1618
Mailing Address - Fax:
Practice Address - Street 1:15900 US-6
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947
Practice Address - Country:US
Practice Address - Phone:570-297-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLO13283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist