Provider Demographics
NPI:1932944725
Name:FARR, KATELYNN LUCILLE (MA CF-SLP)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:LUCILLE
Last Name:FARR
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9751 E GRAND RIVER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-9802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9751 E GRAND RIVER AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-9802
Practice Address - Country:US
Practice Address - Phone:517-376-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITBD235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist