Provider Demographics
NPI:1992269054
Name:LAJEUNESSE, KATHERINE ELIZABETH (SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:LAJEUNESSE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:PERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2711 CAPITAL MEDICAL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4446
Mailing Address - Country:US
Mailing Address - Phone:850-322-8709
Mailing Address - Fax:
Practice Address - Street 1:2711 CAPITAL MEDICAL BLVD STE E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4446
Practice Address - Country:US
Practice Address - Phone:850-322-8709
Practice Address - Fax:850-210-0373
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist