Provider Demographics
NPI:1184090169
Name:HENRY, KATELYN (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 HALTOM ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4197
Mailing Address - Country:US
Mailing Address - Phone:870-919-7192
Mailing Address - Fax:
Practice Address - Street 1:6000 WHITECLIFF DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-8156
Practice Address - Country:US
Practice Address - Phone:870-919-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist