Healthcare Provider Details

I. General information

NPI: 1407672835
Provider Name (Legal Business Name): MISS KATE FIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E BUSTLE ST
LOUDONVILLE OH
44842-1508
US

IV. Provider business mailing address

224 E BUSTLE ST
LOUDONVILLE OH
44842-1508
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-3913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14417120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: