Healthcare Provider Details

I. General information

NPI: 1548196660
Provider Name (Legal Business Name): KATIE LYNETTE LAROCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8452 N OLD WIRE RD
LUMBER BRIDGE NC
28357-8926
US

IV. Provider business mailing address

6920 EDELWEISS PL
FAYETTEVILLE NC
28306-8913
US

V. Phone/Fax

Practice location:
  • Phone: 843-367-5702
  • Fax:
Mailing address:
  • Phone: 843-367-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13624
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: