Provider Demographics
NPI:1093165276
Name:WEATHERMAN, KATE (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:
Last Name:WEATHERMAN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PAINTER ST
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-3830
Mailing Address - Country:US
Mailing Address - Phone:276-236-5641
Mailing Address - Fax:276-236-0699
Practice Address - Street 1:202 PAINTER ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3830
Practice Address - Country:US
Practice Address - Phone:276-236-5154
Practice Address - Fax:276-236-0699
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002581235Z00000X
NC533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist