Provider Demographics
NPI:1194108522
Name:CROCKETT, KATELYN A (AUD)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:A
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 MEMORIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-9500
Mailing Address - Country:US
Mailing Address - Phone:931-645-3937
Mailing Address - Fax:931-645-1043
Practice Address - Street 1:1740 MEMORIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-9500
Practice Address - Country:US
Practice Address - Phone:931-645-3937
Practice Address - Fax:931-645-1043
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1811231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist