Provider Demographics
NPI:1790058642
Name:KATES, ADELE (MED, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:KATES
Suffix:
Gender:F
Credentials:MED, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NE 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3409
Mailing Address - Country:US
Mailing Address - Phone:305-651-6442
Mailing Address - Fax:305-651-5722
Practice Address - Street 1:1 NE 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3409
Practice Address - Country:US
Practice Address - Phone:305-651-6442
Practice Address - Fax:305-651-5722
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist