Provider Demographics
NPI:1851635924
Name:MAIN, KATHRYN LYNN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LYNN
Last Name:MAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LYNN
Other - Last Name:MCDONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4407 N DIVISION ST
Mailing Address - Street 2:STE 303
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1600
Mailing Address - Country:US
Mailing Address - Phone:509-710-5084
Mailing Address - Fax:509-863-9849
Practice Address - Street 1:4407 N DIVISION ST
Practice Address - Street 2:STE 303
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1600
Practice Address - Country:US
Practice Address - Phone:509-710-5084
Practice Address - Fax:509-863-9849
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60306905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD14033267OtherAMERICAN SPEECH AND HEARING ASSOCIATION
WALL60306905OtherSTATE LICENSE