Provider Demographics
NPI:1821379694
Name:RISPOLI, KATHERINE TERESA MCKEON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TERESA MCKEON
Last Name:RISPOLI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:TERESA
Other - Last Name:MCKEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:712 FARM TO MARKET RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1128
Mailing Address - Country:US
Mailing Address - Phone:607-754-1400
Mailing Address - Fax:
Practice Address - Street 1:2693 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MAINE
Practice Address - State:NY
Practice Address - Zip Code:13802-0218
Practice Address - Country:US
Practice Address - Phone:607-862-3263
Practice Address - Fax:607-862-3323
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019806-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12140419OtherASHA NUMBER