Provider Demographics
NPI:1063242964
Name:BATES, KATRINA H (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:H
Last Name:BATES
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 1:4061 E 159 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-3002
Mailing Address - Country:US
Mailing Address - Phone:208-360-2559
Mailing Address - Fax:
Practice Address - Street 1:859 S YELLOWSTONE HWY STE 1702
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5412
Practice Address - Country:US
Practice Address - Phone:208-356-7643
Practice Address - Fax:208-356-7708
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist