Provider Demographics
NPI:1033233598
Name:CLIFFORD, KATHLEEN ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 S OLD US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47854-8015
Mailing Address - Country:US
Mailing Address - Phone:765-562-2938
Mailing Address - Fax:765-245-0332
Practice Address - Street 1:7650 S OLD US HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:IN
Practice Address - Zip Code:47854-8015
Practice Address - Country:US
Practice Address - Phone:765-562-2938
Practice Address - Fax:765-245-0332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003738A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist