Provider Demographics
NPI:1588697213
Name:TOBIN, KATHERINE A (AUD, CCC/A)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:TOBIN
Suffix:
Gender:F
Credentials:AUD, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 E DIVISION ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3748
Mailing Address - Country:US
Mailing Address - Phone:920-926-1288
Mailing Address - Fax:
Practice Address - Street 1:481 E DIVISION ST
Practice Address - Street 2:SUITE 900
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3748
Practice Address - Country:US
Practice Address - Phone:920-926-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI295231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700119179Medicaid
WI41134000Medicaid
P00457648OtherRR MEDICARE
WI68635-0183Medicare ID - Type Unspecified
WI46236-0135Medicare PIN
WI0385-07125Medicare PIN
WIS53291Medicare UPIN
WI1700119179Medicaid
WI01994-0135Medicare PIN