Provider Demographics
NPI:1982585683
Name:WHITE, KATHERINE MACKENZIE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MACKENZIE
Last Name:WHITE
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 1:2690 THUNDERBIRD DR
Mailing Address - Street 2:
Mailing Address - City:KINGDOM CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65262-1816
Mailing Address - Country:US
Mailing Address - Phone:573-386-2214
Mailing Address - Fax:
Practice Address - Street 1:2690 THUNDERBIRD DR
Practice Address - Street 2:
Practice Address - City:KINGDOM CITY
Practice Address - State:MO
Practice Address - Zip Code:65262-1816
Practice Address - Country:US
Practice Address - Phone:573-386-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025034539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist