Provider Demographics
NPI:1760150932
Name:DUMAS, KATHLEEN SHAW (SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SHAW
Last Name:DUMAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SIVILLA
Other - Last Name:DUMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:400 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3143
Mailing Address - Country:US
Mailing Address - Phone:254-215-3316
Mailing Address - Fax:
Practice Address - Street 1:400 N WALL ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3143
Practice Address - Country:US
Practice Address - Phone:254-215-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist