Provider Demographics
NPI:1801325253
Name:THATCH, KIA SIMONE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:SIMONE
Last Name:THATCH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 INTERNATIONAL CIR APT 308
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0137
Mailing Address - Country:US
Mailing Address - Phone:317-363-8834
Mailing Address - Fax:
Practice Address - Street 1:9555 INTERNATIONAL CIR APT 308
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-0137
Practice Address - Country:US
Practice Address - Phone:317-363-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007080A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist