Healthcare Provider Details

I. General information

NPI: 1487114252
Provider Name (Legal Business Name): KATHERINE A TOFAUTE M.S.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MAGAZINE ST
LOUISVILLE KY
40203-2017
US

IV. Provider business mailing address

3202 DUNLOVA CT
LOUISVILLE KY
40241-2114
US

V. Phone/Fax

Practice location:
  • Phone: 502-815-6460
  • Fax:
Mailing address:
  • Phone: 502-526-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number140335
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: