Healthcare Provider Details

I. General information

NPI: 1902309172
Provider Name (Legal Business Name): KATHERINE DOUGLAS SLPD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7802 ANILINE TRL
FORT WAYNE IN
46835-0083
US

IV. Provider business mailing address

7802 ANILINE TRL
FORT WAYNE IN
46835-0083
US

V. Phone/Fax

Practice location:
  • Phone: 916-531-2413
  • Fax:
Mailing address:
  • Phone: 916-531-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSI60783472
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: