Provider Demographics
NPI:1245700434
Name:MAFFETT, KATHARINE SEYMOUR (MCD, CCC-SLP, CBIS)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:SEYMOUR
Last Name:MAFFETT
Suffix:
Gender:F
Credentials:MCD, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PALMER PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6346
Mailing Address - Country:US
Mailing Address - Phone:404-409-0587
Mailing Address - Fax:
Practice Address - Street 1:10144 FORD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3936
Practice Address - Country:US
Practice Address - Phone:912-727-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007862235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist