Provider Demographics
NPI:1336499110
Name:CAVANAUGH, KATHRYN ROSE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 WINDISCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3804
Mailing Address - Country:US
Mailing Address - Phone:513-755-6600
Mailing Address - Fax:513-755-3762
Practice Address - Street 1:9902 WINDISCH RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3804
Practice Address - Country:US
Practice Address - Phone:513-755-6600
Practice Address - Fax:513-755-3762
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187155Medicaid
OHAB7360731Medicare PIN