Provider Demographics
NPI:1992272975
Name:ACKLEY, KATELYN MARY (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:MARY
Last Name:ACKLEY
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 1:102 CUNNINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5609
Mailing Address - Country:US
Mailing Address - Phone:845-702-4928
Mailing Address - Fax:
Practice Address - Street 1:44 FOSTER RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6178
Practice Address - Country:US
Practice Address - Phone:845-223-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028219-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist