Provider Demographics
NPI:1306683289
Name:WHITE, KATILYN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATILYN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 SHELBY GROVE CT APT 205
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2207
Mailing Address - Country:US
Mailing Address - Phone:901-292-5613
Mailing Address - Fax:
Practice Address - Street 1:2000 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5091
Practice Address - Country:US
Practice Address - Phone:901-290-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist