Provider Demographics
NPI:1396045704
Name:O'LEARY, KATHRYN MARIA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIA
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MARIA
Other - Last Name:KENDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 BALLSTON AVE
Mailing Address - Street 2:BALLSTON SPA HIGH SCHOOL
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3606
Mailing Address - Country:US
Mailing Address - Phone:518-884-7150
Mailing Address - Fax:
Practice Address - Street 1:220 BALLSTON AVE
Practice Address - Street 2:BALLSTON SPA HIGH SCHOOL
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-3606
Practice Address - Country:US
Practice Address - Phone:518-884-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018385-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist