Provider Demographics
NPI:1659077360
Name:VISH, KATHRYN ELINOR (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELINOR
Last Name:VISH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELINOR
Other - Last Name:DEWOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:21706 OCONNOR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2955
Mailing Address - Country:US
Mailing Address - Phone:517-945-1971
Mailing Address - Fax:
Practice Address - Street 1:39555 ORCHARD HILL PL STE 410
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5523
Practice Address - Country:US
Practice Address - Phone:248-952-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist