Provider Demographics
NPI:1154699510
Name:LEMLEY, KATIE MIRANDA (SLP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MIRANDA
Last Name:LEMLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 2ND ST
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5014
Mailing Address - Country:US
Mailing Address - Phone:740-678-2499
Mailing Address - Fax:
Practice Address - Street 1:510 5TH ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:OH
Practice Address - Zip Code:45715-8916
Practice Address - Country:US
Practice Address - Phone:740-984-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND2011099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist