Katlyn Rene Niese, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP.14086 Issued in OH

Practice address

109 Auburn Ave
Shelby, OH 44875-1103

Phone

(419) 342-5456

NPI assigned

Feb 17, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650672000000",
    "number": "1912530155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5786 GWIRTZ RD",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448759405",
            "telephone_number": "419-543-1018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 AUBURN AVE",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751103",
            "telephone_number": "419-342-5456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "339 E Maple St",
            "address_purpose": "LOCATION",
            "city": "North Canton",
            "state": "OH",
            "postal_code": "447202593",
            "country_code": "US",
            "telephone_number": "330-498-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIESE",
        "first_name": "KATLYN",
        "middle_name": "RENE",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-17",
        "last_updated": "2022-04-23",
        "certification_date": "2022-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "COND20191193SP",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP.14086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0414168",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Myers
• Burgundy Nace
• Nes of Shelby, Inc.
• Robert Newhon, CDCA
• Aaron Kyle Nickell
• Bradford Russell Noland, CDCA
• Jospeh Norris
• George Novacic
• Megan Lynn Oberhauser, DO
• Ohio Cancer Specialists

• Speech-Language Pathologist in Shelby, OH
• Providers in Shelby, OH by specialty
• Speech-Language Pathologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.