Provider Demographics
NPI:1770037426
Name:SMITH, KATELYN NICHOLS (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:NICHOLS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:MRS
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP, CCC-SLP
Mailing Address - Street 1:635 BEATEN PATH
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2778
Mailing Address - Country:US
Mailing Address - Phone:843-450-8771
Mailing Address - Fax:
Practice Address - Street 1:75 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-3538
Practice Address - Country:US
Practice Address - Phone:843-937-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist