Provider Demographics
NPI:1851502363
Name:LAZZARA, KATHERINE SUE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:SUE
Last Name:LAZZARA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 LINE ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7301
Mailing Address - Country:US
Mailing Address - Phone:610-554-7006
Mailing Address - Fax:
Practice Address - Street 1:494 LINE ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-7301
Practice Address - Country:US
Practice Address - Phone:610-554-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00516200235Z00000X
PASL008427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist