Provider Demographics
NPI:1821290586
Name:SAZONOV, KATHRYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:SAZONOV
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-2006
Mailing Address - Country:US
Mailing Address - Phone:856-566-4580
Mailing Address - Fax:
Practice Address - Street 1:5 EVES DR
Practice Address - Street 2:SUITE 160
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3135
Practice Address - Country:US
Practice Address - Phone:856-985-9257
Practice Address - Fax:856-985-7943
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00242900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist