Provider Demographics
NPI:1750738456
Name:WITCHLEY, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WITCHLEY
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 1:2343 W MAIN ST
Mailing Address - Street 2:APT 1144
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-9003
Mailing Address - Country:US
Mailing Address - Phone:315-525-8498
Mailing Address - Fax:
Practice Address - Street 1:2343 W MAIN ST
Practice Address - Street 2:APT 1144
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-9003
Practice Address - Country:US
Practice Address - Phone:315-525-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ94852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant