Provider Demographics
NPI:1629263900
Name:FEHNEL, KATHY LEE (SLP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LEE
Last Name:FEHNEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LEE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-0295
Mailing Address - Country:US
Mailing Address - Phone:610-207-3773
Mailing Address - Fax:
Practice Address - Street 1:501 S 54TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143
Practice Address - Country:US
Practice Address - Phone:610-207-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist