Provider Demographics
NPI:1295517217
Name:PETSCH, KATHIE-LEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHIE-LEE
Middle Name:
Last Name:PETSCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15287 IONA LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1864
Mailing Address - Country:US
Mailing Address - Phone:305-469-7521
Mailing Address - Fax:
Practice Address - Street 1:15287 IONA LAKES DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1864
Practice Address - Country:US
Practice Address - Phone:305-469-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist