Provider Demographics
NPI:1710986237
Name:VIVALDI, KATHLEEN D (AUD, FAAA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:VIVALDI
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 BERKSHIRE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1268
Mailing Address - Country:US
Mailing Address - Phone:610-374-5599
Mailing Address - Fax:610-288-8075
Practice Address - Street 1:985 BERKSHIRE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1268
Practice Address - Country:US
Practice Address - Phone:610-374-5599
Practice Address - Fax:610-288-8075
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000729L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000241003OtherHIGHMARK BLUE SHIELD