Provider Demographics
NPI:1386769263
Name:DIERSING, KATRINA LOUISE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LOUISE
Last Name:DIERSING
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 1:8204 REGAL PINE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4414
Mailing Address - Country:US
Mailing Address - Phone:502-935-2598
Mailing Address - Fax:
Practice Address - Street 1:7743 SAINT ANDREWS CHURCH RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-3997
Practice Address - Country:US
Practice Address - Phone:502-935-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000380382OtherANTHEM