Provider Demographics
NPI:1700387099
Name:DEROUSSE, KATHERINE E (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:DEROUSSE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:ELISE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6431 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1863
Mailing Address - Country:US
Mailing Address - Phone:314-640-0540
Mailing Address - Fax:
Practice Address - Street 1:16300 JUSTUS POST RD STE 145
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4608
Practice Address - Country:US
Practice Address - Phone:636-614-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist