Provider Demographics
NPI:1326286865
Name:CLEVINGER-MAGIN, KATHY (ST)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CLEVINGER-MAGIN
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 4559
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-4559
Mailing Address - Country:US
Mailing Address - Phone:352-433-0091
Mailing Address - Fax:352-433-0676
Practice Address - Street 1:14031 DEL WEBB BOULEVARD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-7957
Practice Address - Country:US
Practice Address - Phone:352-433-0091
Practice Address - Fax:352-433-0676
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist