Provider Demographics
NPI:1417354143
Name:DENNIS, KATHRYN MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARIE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:35919 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006-9413
Mailing Address - Country:US
Mailing Address - Phone:719-948-4351
Mailing Address - Fax:
Practice Address - Street 1:35919 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-9413
Practice Address - Country:US
Practice Address - Phone:719-948-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001532235Z00000X
OHSP.11332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist