Provider Demographics
NPI:1508443524
Name:LALONDE, KATHLEEN RYAN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RYAN
Last Name:LALONDE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:RYAN
Other - Last Name:LALONDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3466 YARNEY RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2780
Mailing Address - Country:US
Mailing Address - Phone:248-302-6372
Mailing Address - Fax:
Practice Address - Street 1:11911 CLINTON RIVER RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2420
Practice Address - Country:US
Practice Address - Phone:586-797-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000009072255A2300X
MI26010011812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer