Provider Demographics
NPI:1801570973
Name:TALLON, KATELYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:TALLON
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 1:1043 DOCTOR HARDY CIR
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2774
Mailing Address - Country:US
Mailing Address - Phone:843-632-1731
Mailing Address - Fax:
Practice Address - Street 1:1990 AUGUSTA ST STE 2500
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6510
Practice Address - Country:US
Practice Address - Phone:864-370-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist