Provider Demographics
NPI:1528574654
Name:K.D. SPEECH PATHOLOGY, PC
Entity Type:Organization
Organization Name:K.D. SPEECH PATHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:914-393-7939
Mailing Address - Street 1:546 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1037
Mailing Address - Country:US
Mailing Address - Phone:914-393-7939
Mailing Address - Fax:
Practice Address - Street 1:546 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1037
Practice Address - Country:US
Practice Address - Phone:914-393-7939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty