Provider Demographics
NPI:1144380007
Name:WYATT, KATHRYN G (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:G
Last Name:WYATT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8694 POPLAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3212
Mailing Address - Country:US
Mailing Address - Phone:154-541-0976
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:8694 POPLAR CREEK RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-3212
Practice Address - Country:US
Practice Address - Phone:615-454-1097
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP14734235Z00000X
NH2404235Z00000X
NY25213235Z00000X
OK6092235Z00000X
TN3368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist