Provider Demographics
NPI:1629377783
Name:KING, KATHLEEN DENISE (SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DENISE
Last Name:KING
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14128 255TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2642
Mailing Address - Country:US
Mailing Address - Phone:718-949-9238
Mailing Address - Fax:
Practice Address - Street 1:29-01 216TH STREET
Practice Address - Street 2:ST. MARY'S HOSPITAL FOR CHILDREN
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2899
Practice Address - Country:US
Practice Address - Phone:718-281-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006737-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist