Provider Demographics
NPI:1578170262
Name:RYAN, KATHRYN GILLIGAN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GILLIGAN
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BUTCH SONGIN CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02071-1111
Mailing Address - Country:US
Mailing Address - Phone:347-687-7570
Mailing Address - Fax:508-660-7051
Practice Address - Street 1:71 ELM ST STE 8
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2519
Practice Address - Country:US
Practice Address - Phone:347-687-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3402-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist