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General NPI Number Information
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NPI Number | 1801570973
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Entity Type | Individual
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Provider Name | KATELYN TALLON CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 1990 AUGUSTA ST STE 2500
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City | GREENVILLE
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State | SC
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Zip | 29605-6510
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Country | US
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Telephone | 864-370-0131
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Fax |
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Provider Business Mailing Address
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Address Line | 1043 DOCTOR HARDY CIR
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City | DILLON
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State | SC
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Zip | 29536-2774
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Country | US
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Telephone | 843-632-1731
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7980
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License Number State | SC
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