Provider Demographics
NPI:1164639316
Name:NEIGHBOR, KATHRYN L (MS CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:NEIGHBOR
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PRAIRIE BLUFFS DR
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348
Mailing Address - Country:US
Mailing Address - Phone:850-774-7421
Mailing Address - Fax:
Practice Address - Street 1:124 PRAIRIE BLUFFS DR
Practice Address - Street 2:
Practice Address - City:FORISTELL
Practice Address - State:MO
Practice Address - Zip Code:63348
Practice Address - Country:US
Practice Address - Phone:850-774-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2336235Z00000X
MO02070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000904500Medicaid
MO1032733Medicaid