Provider Demographics
NPI:1417306564
Name:KOHLMANN, MARDEE (MS, MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:MARDEE
Middle Name:
Last Name:KOHLMANN
Suffix:
Gender:F
Credentials:MS, MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W MICHIGAN AVE
Mailing Address - Street 2:#2
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5439
Mailing Address - Country:US
Mailing Address - Phone:419-290-5886
Mailing Address - Fax:
Practice Address - Street 1:112 W MICHIGAN AVE
Practice Address - Street 2:#2
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5439
Practice Address - Country:US
Practice Address - Phone:419-290-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program