Provider Demographics
NPI:1740408400
Name:HAMMOND, KATHRYN AVILA (MS, CCC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:AVILA
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-9070
Mailing Address - Country:US
Mailing Address - Phone:928-854-2148
Mailing Address - Fax:928-453-0418
Practice Address - Street 1:3334 CANDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-9070
Practice Address - Country:US
Practice Address - Phone:928-854-2148
Practice Address - Fax:928-453-0418
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist