Provider Demographics
NPI:1881145472
Name:RIZCO, KATIE ELLEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELLEN
Last Name:RIZCO
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 1:121 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-1537
Mailing Address - Country:US
Mailing Address - Phone:937-707-9058
Mailing Address - Fax:
Practice Address - Street 1:6800 GENDER RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8232
Practice Address - Country:US
Practice Address - Phone:614-834-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND. 2017041235Z00000X
OHSP.12817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist