Healthcare Provider Details

I. General information

NPI: 1114837838
Provider Name (Legal Business Name): KATHERINE KIRSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 HIGHWAY 160 W STE 240
FORT MILL SC
29708-8035
US

IV. Provider business mailing address

1698 HIGHWAY 160 W STE 240
FORT MILL SC
29708-8035
US

V. Phone/Fax

Practice location:
  • Phone: 704-654-8599
  • Fax: 980-938-6088
Mailing address:
  • Phone: 704-654-8599
  • Fax: 980-938-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9884
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005644
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: