Provider Demographics
NPI:1154679900
Name:DEERING, KATHLEEN (CCC-SP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DEERING
Suffix:
Gender:F
Credentials:CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4558
Mailing Address - Country:US
Mailing Address - Phone:330-668-4041
Mailing Address - Fax:330-666-5626
Practice Address - Street 1:3428 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3339
Practice Address - Country:US
Practice Address - Phone:330-668-4041
Practice Address - Fax:330-666-5626
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 2982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist