Provider Demographics
NPI:1962824565
Name:SAMMETINGER, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SAMMETINGER
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 1:1225 W LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2068
Mailing Address - Country:US
Mailing Address - Phone:419-586-8300
Mailing Address - Fax:
Practice Address - Street 1:17007 FREYBURG EAST RD
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-8716
Practice Address - Country:US
Practice Address - Phone:419-738-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist