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General NPI Number Information
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NPI Number | 1275966103
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Entity Type | Individual
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Provider Name | KATLYN ANTONIA ENGEBRETSEN MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 933 E PIERCE ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4626
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Country | US
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Telephone | 712-396-4317
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Fax |
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Provider Business Mailing Address
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Address Line | 8513 S 46TH ST
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City | OMAHA
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State | NE
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Zip | 68157-2619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 002327
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License Number State | NE
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