Provider Demographics
NPI:1659596385
Name:LOVE, KATHY (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 HAYES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9773
Mailing Address - Country:US
Mailing Address - Phone:406-880-3468
Mailing Address - Fax:406-829-6349
Practice Address - Street 1:1931 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2241
Practice Address - Country:US
Practice Address - Phone:406-829-6349
Practice Address - Fax:406-829-6349
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT519235Z00000X
MT4096172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No172M00000XOther Service ProvidersMechanotherapist