Provider Demographics
NPI:1679709992
Name:ALDRIDGE, KATHLEEN VERNICE (MEDICAL TECHNOLOGIST)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VERNICE
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:MEDICAL TECHNOLOGIST
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:VERNICE
Other - Last Name:JACO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICAL TECHNOLOGIST
Mailing Address - Street 1:924 LANSFAIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9066
Mailing Address - Country:US
Mailing Address - Phone:843-852-5580
Mailing Address - Fax:
Practice Address - Street 1:924 LANSFAIRE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9066
Practice Address - Country:US
Practice Address - Phone:843-852-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108812246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
108812OtherAMERICAN SOCIETY FOR CLINICAL PATHOLOGY