Provider Demographics
NPI:1205124443
Name:VANENKEVORT, KATHERINE SUZANNE (SLPD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:VANENKEVORT
Suffix:
Gender:
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3405
Mailing Address - Country:US
Mailing Address - Phone:906-280-7574
Mailing Address - Fax:906-428-8843
Practice Address - Street 1:218 S 10TH ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3405
Practice Address - Country:US
Practice Address - Phone:069-553-7574
Practice Address - Fax:906-428-8843
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MI7101002388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist