Provider Demographics
NPI:1760944045
Name:SHRADER, KATIE (HAS, BC-HIS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SHRADER
Suffix:
Gender:F
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 TREASURE COAST PLZ STE B
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0930
Mailing Address - Country:US
Mailing Address - Phone:772-564-7200
Mailing Address - Fax:772-564-9179
Practice Address - Street 1:2046 TREASURE COAST PLZ STE B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0930
Practice Address - Country:US
Practice Address - Phone:772-564-7200
Practice Address - Fax:772-564-9179
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5220237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist