Provider Demographics
NPI:1548774490
Name:TOMMILA, KATIE ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:TOMMILA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 VIA SEDILLO
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7853
Mailing Address - Country:US
Mailing Address - Phone:314-677-5960
Mailing Address - Fax:
Practice Address - Street 1:171 VIA SEDILLO
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7853
Practice Address - Country:US
Practice Address - Phone:314-677-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist