Provider Demographics
NPI:1689927881
Name:MCCORMICK, KATIE ELISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELISE
Last Name:MCCORMICK
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 1:109 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4841
Mailing Address - Country:US
Mailing Address - Phone:615-788-3365
Mailing Address - Fax:
Practice Address - Street 1:109 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4841
Practice Address - Country:US
Practice Address - Phone:615-788-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist