Provider Demographics
NPI:1861797557
Name:KATIBI, LAYO (SLP)
Entity type:Individual
Prefix:
First Name:LAYO
Middle Name:
Last Name:KATIBI
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 UNDERHILL AVE
Mailing Address - Street 2:APARTMENT 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3126
Mailing Address - Country:US
Mailing Address - Phone:917-862-3524
Mailing Address - Fax:
Practice Address - Street 1:44 UNDERHILL AVE
Practice Address - Street 2:APARTMENT 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3126
Practice Address - Country:US
Practice Address - Phone:917-862-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist