Provider Demographics
NPI:1952068454
Name:CROFT, KATIE ANN
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:CROFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SUMMIT COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-0108
Mailing Address - Country:US
Mailing Address - Phone:229-456-1179
Mailing Address - Fax:
Practice Address - Street 1:536 GRAND SLAM DR STE D
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8045
Practice Address - Country:US
Practice Address - Phone:706-854-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET0033700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist