Provider Demographics
NPI:1033524566
Name:CALLAGHAN, KATHLEEN ENGELS (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ENGELS
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PRIDHAM LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:VA
Mailing Address - Zip Code:22503-4177
Mailing Address - Country:US
Mailing Address - Phone:804-462-0606
Mailing Address - Fax:
Practice Address - Street 1:10300 SW GREENBURG RD
Practice Address - Street 2:ONE LINCOLN CENTER, SUITE 410
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5410
Practice Address - Country:US
Practice Address - Phone:503-517-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist