1447412218 NPI number — KATHERINE LANIER SLADE AUD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447412218 NPI number — KATHERINE LANIER SLADE AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLADE
Provider First Name:
KATHERINE
Provider Middle Name:
LANIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANIER
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
BAILEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447412218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7145 HALCYON SUMMIT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-6971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-244-3408
Provider Business Mailing Address Fax Number:
334-244-3906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7145 HALCYON SUMMIT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-6971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-244-3355
Provider Business Practice Location Address Fax Number:
334-244-3906
Provider Enumeration Date:
07/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AUD003801 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 1108A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1108A . This is a "AL AUDIOLOGY LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: AUD003801 . This is a "GA AUDIOLOGY LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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