Provider Demographics
NPI:1588034904
Name:DALTON, KEVIN PATRICK
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:DALTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4912
Mailing Address - Country:US
Mailing Address - Phone:732-779-7726
Mailing Address - Fax:
Practice Address - Street 1:384 UNION ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4912
Practice Address - Country:US
Practice Address - Phone:732-779-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist