Provider Demographics
NPI:1053097154
Name:MICHELETTI, KATIE (AUD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MICHELETTI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 25TH AVE S UNIT 437
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5322
Mailing Address - Country:US
Mailing Address - Phone:925-209-1709
Mailing Address - Fax:
Practice Address - Street 1:5821 S SPRAGUE CT
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6903
Practice Address - Country:US
Practice Address - Phone:253-396-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61445493231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist