Provider Demographics
NPI:1982918876
Name:SMALL, KATIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 POLE LINE RD W STE 3802
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5811
Mailing Address - Country:US
Mailing Address - Phone:208-814-3450
Mailing Address - Fax:208-814-3920
Practice Address - Street 1:801 POLE LINE RD W STE 3802
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5811
Practice Address - Country:US
Practice Address - Phone:208-814-3450
Practice Address - Fax:208-814-3920
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist