Provider Demographics
NPI:1669486791
Name:PREVOST, KATHRYN MARY (AUD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARY
Last Name:PREVOST
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 FULTON ST W
Mailing Address - Street 2:APT. 1216
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-6201
Mailing Address - Country:US
Mailing Address - Phone:616-855-6207
Mailing Address - Fax:
Practice Address - Street 1:393 ROOSEVELT AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3333
Practice Address - Country:US
Practice Address - Phone:586-243-3246
Practice Address - Fax:269-441-4150
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000171231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist