Provider Demographics
NPI:1558815373
Name:O'BRIEN, KATHRYN (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ADERHOLD HL
Mailing Address - Street 2:110 CARLTON STREET
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:593 ADERHOLD HL
Practice Address - Street 2:110 CARLTON STREET
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-0001
Practice Address - Country:US
Practice Address - Phone:706-542-4598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist