Provider Demographics
NPI:1578104147
Name:GALLOWAY, KATHRYN M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:GALLOWAY
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 1:17786 69TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3003
Mailing Address - Country:US
Mailing Address - Phone:612-308-4065
Mailing Address - Fax:
Practice Address - Street 1:26934 N 178TH AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-1075
Practice Address - Country:US
Practice Address - Phone:623-980-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP12099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist