Provider Demographics
NPI:1558600452
Name:MACHTOLFF, KATHLEEN LYONS
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LYONS
Last Name:MACHTOLFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYONS
Other - Last Name:MACHTOLFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3605 RATLIFF RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-4512
Mailing Address - Country:US
Mailing Address - Phone:205-956-2184
Mailing Address - Fax:
Practice Address - Street 1:3605 RATLIFF RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-4512
Practice Address - Country:US
Practice Address - Phone:205-956-2184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist