Provider Demographics
NPI:1043891021
Name:KING, KATHERINE ANNE (CF-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:KING
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3847
Mailing Address - Country:US
Mailing Address - Phone:402-707-8009
Mailing Address - Fax:
Practice Address - Street 1:3215 CUMING ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2000
Practice Address - Country:US
Practice Address - Phone:531-299-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20200007183163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE05Medicaid