Provider Demographics
NPI:1215523550
Name:BEDNARZ, KATIE (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:
Last Name:BEDNARZ
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 1:561 BLACK PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-9515
Mailing Address - Country:US
Mailing Address - Phone:860-685-1185
Mailing Address - Fax:
Practice Address - Street 1:166 BAY SPRING AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1393
Practice Address - Country:US
Practice Address - Phone:401-359-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI14290857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist