Provider Demographics
NPI:1518277292
Name:REGISTER, KATHLEEN THERESE (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:THERESE
Last Name:REGISTER
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:THERESE
Other - Last Name:BUTANOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:2955 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3205
Mailing Address - Country:US
Mailing Address - Phone:305-444-9259
Mailing Address - Fax:
Practice Address - Street 1:2955 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3205
Practice Address - Country:US
Practice Address - Phone:305-444-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist