Provider Demographics
NPI:1578884813
Name:BOLLIN, KATHERINE M (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:BOLLIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:PIETKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-2112
Mailing Address - Country:US
Mailing Address - Phone:518-482-8805
Mailing Address - Fax:
Practice Address - Street 1:2072 CURRY RD
Practice Address - Street 2:MOHONASEN HIGH SCHOOL
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4400
Practice Address - Country:US
Practice Address - Phone:518-356-8343
Practice Address - Fax:518-356-8309
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004055--1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist