Provider Demographics
NPI:1194017087
Name:DIAZ, KATHRYN (MA,CCC-SLP,TSHH, BIL)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA,CCC-SLP,TSHH, BIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2831
Mailing Address - Country:US
Mailing Address - Phone:917-880-7519
Mailing Address - Fax:
Practice Address - Street 1:6814 78TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2831
Practice Address - Country:US
Practice Address - Phone:917-880-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016062-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist