Provider Demographics
NPI:1841424983
Name:BACH-ELKINS, KATHRYN SUE (EDS, CCC-SLP-L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUE
Last Name:BACH-ELKINS
Suffix:
Gender:F
Credentials:EDS, CCC-SLP-L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:S
Other - Last Name:DIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 ENOTAH LN
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-5487
Mailing Address - Country:US
Mailing Address - Phone:770-312-6989
Mailing Address - Fax:770-312-6989
Practice Address - Street 1:5150 STILESBORO RD NW STE 140
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7744
Practice Address - Country:US
Practice Address - Phone:770-218-2300
Practice Address - Fax:770-218-2301
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist