Provider Demographics
NPI:1114012424
Name:KESSLER, KATHY S (MS, CCC-SP/A)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:S
Last Name:KESSLER
Suffix:
Gender:F
Credentials:MS, CCC-SP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 FRIENDSHIP DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-4434
Mailing Address - Country:US
Mailing Address - Phone:317-710-3164
Mailing Address - Fax:317-889-9799
Practice Address - Street 1:1814 FRIENDSHIP DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-4434
Practice Address - Country:US
Practice Address - Phone:317-710-3164
Practice Address - Fax:317-889-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001669A235Z00000X
IN23001669A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200600700Medicaid