Provider Demographics
NPI:1912207390
Name:LAMB, KATHERINE MARIE (MS)
Entity Type:Individual
Prefix:PROF
First Name:KATHERINE
Middle Name:MARIE
Last Name:LAMB
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 E FOWLER AVE STOP PCD1017
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33620-6750
Mailing Address - Country:US
Mailing Address - Phone:813-974-9844
Mailing Address - Fax:813-974-0822
Practice Address - Street 1:4202 E FOWLER AVE STOP PCD1017
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-6750
Practice Address - Country:US
Practice Address - Phone:813-974-8844
Practice Address - Fax:813-974-0822
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003007700Medicaid
FLEK751ZMedicare PIN