Provider Demographics
NPI:1497084735
Name:KING, KATHY LEIGH (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LEIGH
Last Name:KING
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 LAKE CHARLES WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3316
Mailing Address - Country:US
Mailing Address - Phone:404-425-4948
Mailing Address - Fax:770-645-1313
Practice Address - Street 1:670 LAKE CHARLES WAY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3316
Practice Address - Country:US
Practice Address - Phone:404-425-4948
Practice Address - Fax:770-645-1313
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist