Provider Demographics
NPI:1538319157
Name:BLOCK, KATHERINE MONICA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MONICA
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N MILWAUKEE ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5803
Mailing Address - Country:US
Mailing Address - Phone:414-615-0665
Mailing Address - Fax:
Practice Address - Street 1:5015 N. 106TH ST.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225
Practice Address - Country:US
Practice Address - Phone:262-510-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI#3090-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist