Provider Demographics
NPI:1386077451
Name:JANELLE, KATHERINE ANNE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:JANELLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:200 LUCY P EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-8220
Mailing Address - Country:US
Mailing Address - Phone:864-476-3174
Mailing Address - Fax:
Practice Address - Street 1:200 LUCY P EDWARDS RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-8220
Practice Address - Country:US
Practice Address - Phone:864-476-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC14037987OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION: CERTIFICATE OF CLINICAL COMPETENCE
SC265344OtherSOUTH CAROLINA STATE BOARD OF EDUCATION: EDUCATOR LICENSE
SC5360OtherDEPARTMENT OF LLR: BOARD OF EXAMINERS IN SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY