Provider Demographics
NPI:1518412444
Name:SIMON, KATHLEEN ANNE (MA, CCC-LSLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA, CCC-LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14743-9769
Mailing Address - Country:US
Mailing Address - Phone:716-557-2227
Mailing Address - Fax:716-557-2259
Practice Address - Street 1:3701 MAIN ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:NY
Practice Address - Zip Code:14743-9769
Practice Address - Country:US
Practice Address - Phone:716-557-2227
Practice Address - Fax:716-557-2259
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist