Provider Demographics
NPI:1407272271
Name:SLABOCH, KATHRYN D'AMBROSE (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D'AMBROSE
Last Name:SLABOCH
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 N MARSHALL ST APT 21
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3901
Mailing Address - Country:US
Mailing Address - Phone:630-300-4270
Mailing Address - Fax:
Practice Address - Street 1:10243 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2028
Practice Address - Country:US
Practice Address - Phone:414-604-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3931154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist