Provider Demographics
NPI:1790358737
Name:FAUST, KATIE LYN (MA, CCC- SLP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN
Last Name:FAUST
Suffix:
Gender:F
Credentials:MA, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 PALM TERRACE LOOP
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8655
Mailing Address - Country:US
Mailing Address - Phone:631-559-5047
Mailing Address - Fax:
Practice Address - Street 1:2848 PLEASANT RD STE 1091
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9490
Practice Address - Country:US
Practice Address - Phone:800-779-4089
Practice Address - Fax:803-547-9706
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist