Provider Demographics
NPI:1477035483
Name:DISLEY, KATHRYN ELIZABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:DISLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:3440 MOSCOW RD
Mailing Address - Street 2:
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283-9712
Mailing Address - Country:US
Mailing Address - Phone:517-262-7309
Mailing Address - Fax:
Practice Address - Street 1:524 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2804
Practice Address - Country:US
Practice Address - Phone:517-782-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist