Provider Demographics
NPI:1740596519
Name:MERRILL, KATHY E (SLP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:E
Last Name:MERRILL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 DRUMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5755
Mailing Address - Country:US
Mailing Address - Phone:207-873-0695
Mailing Address - Fax:
Practice Address - Street 1:58 DRUMMOND AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5755
Practice Address - Country:US
Practice Address - Phone:207-873-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist