Provider Demographics
NPI:1275879462
Name:DRASIEWSKI, KATHLEEN KRYSTYNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:KRYSTYNA
Last Name:DRASIEWSKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-6978
Mailing Address - Country:US
Mailing Address - Phone:419-784-5878
Mailing Address - Fax:
Practice Address - Street 1:1447 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-6978
Practice Address - Country:US
Practice Address - Phone:419-784-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist