Provider Demographics
NPI:1790272938
Name:WEST, KATELYN WILSON (HAS)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:WILSON
Last Name:WEST
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ELIZABETH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:270 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1326
Mailing Address - Country:US
Mailing Address - Phone:256-927-5813
Mailing Address - Fax:256-927-5818
Practice Address - Street 1:270 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1326
Practice Address - Country:US
Practice Address - Phone:256-927-5813
Practice Address - Fax:256-927-5818
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4212237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist