=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598418576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE LYNN EDNIE MS, CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2022
-----------------------------------------------------
Last Update Date | 01/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2888 RINGLING BLVD UNIT CD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-5331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-413-5100
-----------------------------------------------------
Fax | 941-388-7292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2260 RINGLING BLVD UNIT 406
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-6163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-494-4644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 14732
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------