Provider Demographics
NPI:1316367501
Name:PALATUCCI, KATHLEEN (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PALATUCCI
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:HORNER
Other - Last Name:PALATUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:41YS00331400
Mailing Address - Street 1:24 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2222
Mailing Address - Country:US
Mailing Address - Phone:973-857-7014
Mailing Address - Fax:
Practice Address - Street 1:1515 BROAD ST BLDG B
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3002
Practice Address - Country:US
Practice Address - Phone:973-655-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-26
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00331400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist