Provider Demographics
NPI:1740473107
Name:HIGINBOTHAM, KATHERINE SUZANNE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:HIGINBOTHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 HANCOCK ST STE 27
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5885
Mailing Address - Country:US
Mailing Address - Phone:317-688-1113
Mailing Address - Fax:317-975-0650
Practice Address - Street 1:12315 HANCOCK ST STE 27
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5885
Practice Address - Country:US
Practice Address - Phone:317-688-1113
Practice Address - Fax:317-975-0650
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002379A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist