MEDICARE: KIA SIMONE THATCH CCC-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	22007080A	IN
2	235Z00000X	Speech-Language Pathologist	30003919	NC

General Provider Information

NPI Number	:	1801325253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIA SIMONE THATCH CCC-SLP

Provider Business Mailing Address
First Line	:	9555 INTERNATIONAL CIR APT 308
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-0137
Country	:	US
Telephone Number	:	317-363-8834
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 ARROWPOINT BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-8166
Country	:	US
Telephone Number	:	704-426-3353
Fax Number	:	980-392-5580

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	06/26/2025

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Directions to “ KIA SIMONE THATCH CCC-SLP” Practice Location

Language	Start Address	Practice Location

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