Provider Demographics
NPI:1992368260
Name:RANDALL, KATE LAURYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:LAURYN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 NASHVILLE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2070
Mailing Address - Country:US
Mailing Address - Phone:931-490-7770
Mailing Address - Fax:931-490-7771
Practice Address - Street 1:1511 NASHVILLE HWY STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2070
Practice Address - Country:US
Practice Address - Phone:931-490-7770
Practice Address - Fax:931-490-7771
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist