Provider Demographics
NPI:1518627611
Name:BANNISTER, KATHLEEN (SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8453
Mailing Address - Country:US
Mailing Address - Phone:919-460-1921
Mailing Address - Fax:919-460-1929
Practice Address - Street 1:100 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8453
Practice Address - Country:US
Practice Address - Phone:919-460-1921
Practice Address - Fax:919-460-1929
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty