Provider Demographics
NPI:1710026901
Name:CLUTTER, KATHLEEN PATRICIA (MA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:CLUTTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:PATRICIA
Other - Last Name:KIRKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:19021 120TH AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9511
Mailing Address - Country:US
Mailing Address - Phone:425-486-7710
Mailing Address - Fax:
Practice Address - Street 1:19021 120TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9511
Practice Address - Country:US
Practice Address - Phone:425-486-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI00004315235Z00000X
WALL00004721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist