Provider Demographics
NPI:1386369197
Name:DONALDSON, KATELYN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:DONALDSON
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 1:319 CAMDEN HL # HI
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8779
Mailing Address - Country:US
Mailing Address - Phone:318-664-0561
Mailing Address - Fax:
Practice Address - Street 1:4350 VIKING LOOP
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7421
Practice Address - Country:US
Practice Address - Phone:318-746-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist