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General NPI Number Information
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NPI Number | 1932365459
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Entity Type | Individual
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Provider Name | KATIE ELIZABETH PERNOTTO M.ED.
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 850 E BUTLER RD
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City | GREENVILLE
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State | SC
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Zip | 29607-5842
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Country | US
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Telephone | 864-527-9454
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Fax |
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Provider Business Mailing Address
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Address Line | 850 E BUTLER RD
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City | GREENVILLE
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State | SC
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Zip | 29607-5842
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Country | US
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Telephone | 706-664-8192
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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 | 4328
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License Number State | SC
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