MEDICARE: KATIE A DEBICKI SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	242000708	IL
2	235Z00000X	Speech-Language Pathologist	22004936A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033391412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE A DEBICKI SLP

Provider Business Mailing Address
First Line	:	524 E MCKINLEY AVE
Second Line	:	STE 1
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-6285
Country	:	US
Telephone Number	:	574-255-8730
Fax Number	:	574-255-8732

Provider Business Practice Location Address
First Line	:	3222 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2352
Country	:	US
Telephone Number	:	574-255-8730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	06/24/2024

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Directions to “ KATIE A DEBICKI SLP” Practice Location

Language	Start Address	Practice Location

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