Provider Demographics
NPI:1144601642
Name:KEARNEY, KATINA LYNN (HIS)
Entity Type:Individual
Prefix:MRS
First Name:KATINA
Middle Name:LYNN
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E VIEW LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-5324
Mailing Address - Country:US
Mailing Address - Phone:802-223-0068
Mailing Address - Fax:802-223-6987
Practice Address - Street 1:58 E VIEW LN
Practice Address - Street 2:SUITE D
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5324
Practice Address - Country:US
Practice Address - Phone:802-223-0068
Practice Address - Fax:802-223-6987
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0630109137237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist