Provider Demographics
NPI:1295204758
Name:CONN, KATHLINE K (MA- SLP)
Entity Type:Individual
Prefix:
First Name:KATHLINE
Middle Name:K
Last Name:CONN
Suffix:
Gender:F
Credentials:MA- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7708
Mailing Address - Country:US
Mailing Address - Phone:515-401-0090
Mailing Address - Fax:
Practice Address - Street 1:2400 6TH AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3541
Practice Address - Country:US
Practice Address - Phone:515-401-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist