Provider Demographics
NPI:1972230548
Name:BOARD, KATELYN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:BOARD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:WILK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2685 CELANESE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-372-8415
Mailing Address - Fax:
Practice Address - Street 1:2685 CELANESE RD STE 105
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2994
Practice Address - Country:US
Practice Address - Phone:803-661-5033
Practice Address - Fax:864-643-2327
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist