Provider Demographics
NPI:1750609996
Name:KIIHNL, KATELYN JO (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:JO
Last Name:KIIHNL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:JO
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-6958
Mailing Address - Country:US
Mailing Address - Phone:870-793-2877
Mailing Address - Fax:
Practice Address - Street 1:415 ALLEN ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-6958
Practice Address - Country:US
Practice Address - Phone:870-793-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182084721Medicaid