Provider Demographics
NPI:1073942280
Name:LACAPA-BOEGL, KATHY (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LACAPA-BOEGL
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 1:304 EKLUND ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-1041
Mailing Address - Country:US
Mailing Address - Phone:816-540-2119
Mailing Address - Fax:
Practice Address - Street 1:304 EKLUND ST
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-1041
Practice Address - Country:US
Practice Address - Phone:816-540-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011014234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist