Provider Demographics
NPI:1356912075
Name:SHAW, KATLYN DANIEL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:DANIEL
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 GILL FIELD RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9569
Mailing Address - Country:US
Mailing Address - Phone:270-339-8740
Mailing Address - Fax:
Practice Address - Street 1:23 W CENTER ST FL 1
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1941
Practice Address - Country:US
Practice Address - Phone:270-452-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty