Provider Demographics
NPI:1821316514
Name:ADAMS, KATHY JO (KATHY ADAMS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JO
Last Name:ADAMS
Suffix:
Gender:F
Credentials:KATHY ADAMS
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KATHY ADAMS
Mailing Address - Street 1:485 MISSION VIEW DR
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-4142
Mailing Address - Country:US
Mailing Address - Phone:406-883-9272
Mailing Address - Fax:
Practice Address - Street 1:485 MISSION VIEW DR
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-4142
Practice Address - Country:US
Practice Address - Phone:406-883-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist