Provider Demographics
NPI:1437373255
Name:RALSTON, KATHY T (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:T
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HICKORY CT
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8165
Mailing Address - Country:US
Mailing Address - Phone:501-607-3194
Mailing Address - Fax:
Practice Address - Street 1:15 HICKORY CT
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-8165
Practice Address - Country:US
Practice Address - Phone:501-607-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP# 1630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist