Provider Demographics
NPI:1043588460
Name:EWART, KATHERINE JOAN (MS CCC/SP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JOAN
Last Name:EWART
Suffix:
Gender:F
Credentials:MS CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W CANON DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3638
Mailing Address - Country:US
Mailing Address - Phone:585-594-2009
Mailing Address - Fax:
Practice Address - Street 1:1305 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2119
Practice Address - Country:US
Practice Address - Phone:585-458-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6607-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist