Provider Demographics
NPI:1679183768
Name:FERRELLI, KATHLEEN (SP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FERRELLI
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SP
Mailing Address - Street 1:1445 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2017
Mailing Address - Country:US
Mailing Address - Phone:931-372-2020
Mailing Address - Fax:931-372-2572
Practice Address - Street 1:1445 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2017
Practice Address - Country:US
Practice Address - Phone:931-372-2020
Practice Address - Fax:931-372-2572
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist