Provider Demographics
NPI:1649452665
Name:ALBERTSON, KATHERINE ANNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:ALBERTSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SCHILLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 IPSWICH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5971
Mailing Address - Country:US
Mailing Address - Phone:608-931-9323
Mailing Address - Fax:
Practice Address - Street 1:1221 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7163
Practice Address - Country:US
Practice Address - Phone:608-931-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12158235Z00000X
AZSLP5658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008925800Medicaid