Provider Demographics
NPI:1346529419
Name:ANDERSON, KATHRYN ANNE (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 N 161ST AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2893
Mailing Address - Country:US
Mailing Address - Phone:402-493-2530
Mailing Address - Fax:402-493-2529
Practice Address - Street 1:3814 N 161ST AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2893
Practice Address - Country:US
Practice Address - Phone:402-493-2530
Practice Address - Fax:402-493-2529
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist