Provider Demographics
NPI:1265791230
Name:REILY, KATIE BURNS (SLP)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:BURNS
Last Name:REILY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GALILEAN TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8132
Mailing Address - Country:US
Mailing Address - Phone:919-225-4643
Mailing Address - Fax:919-933-3601
Practice Address - Street 1:1200 GALILEAN TRL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8132
Practice Address - Country:US
Practice Address - Phone:919-225-4643
Practice Address - Fax:919-933-3601
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist