Provider Demographics
NPI:1437662525
Name:SONDERMAN, KATHRYN ROSE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ROSE
Last Name:SONDERMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:DILGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1426 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3734
Mailing Address - Country:US
Mailing Address - Phone:440-465-3513
Mailing Address - Fax:
Practice Address - Street 1:2155 MIRAMAR BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3301
Practice Address - Country:US
Practice Address - Phone:216-371-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0252509Medicaid