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General NPI Number Information
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NPI Number | 1790026417
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Entity Type | Individual
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Provider Name | KATIE LAUREN KILLEBREW
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 2762 WAVERLEY DR
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City | TROPHY CLUB
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State | TX
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Zip | 76262-3424
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Country | US
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Telephone | 469-768-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 3805 MOORCROFT RD
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City | FRISCO
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State | TX
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Zip | 75036-8226
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Country | US
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Telephone | 361-648-1295
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 36387
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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