Basic Information
| Provider Information | |||||||||
| NPI: | 1083963557 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DOERNER | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6977 PROFESSIONAL PKWY E | ||||||||
| Address2: | THERAPEUTIC POTENTIALS, INC. | ||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Practice Location | |||||||||
| Address1: | 6977 PROFESSIONAL PKWY E | ||||||||
| Address2: | THERAPEUTIC POTENTIALS, INC. | ||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342408411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2012 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ5918 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SA12659 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 006668100 | 05 | FL | MEDICAID |