Provider Demographics
NPI:1699203299
Name:BURTTRAM, KATHERINE JENNINGS
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JENNINGS
Last Name:BURTTRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CIRCLE AVE APT I
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1440
Mailing Address - Country:US
Mailing Address - Phone:843-909-0363
Mailing Address - Fax:
Practice Address - Street 1:333 CIRCLE AVE APT I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1440
Practice Address - Country:US
Practice Address - Phone:843-909-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist