Provider Demographics
NPI:1649839671
Name:STEVENSON, KATIE (AUD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 MONROE ST STE A
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3038
Mailing Address - Country:US
Mailing Address - Phone:313-562-4100
Mailing Address - Fax:
Practice Address - Street 1:2454 MONROE ST STE A
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3038
Practice Address - Country:US
Practice Address - Phone:313-562-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1601000840OtherLICENSE