Provider Demographics
NPI:1851715023
Name:BREWINGTON, KATHLYN R (SLP/CCC)
Entity Type:Individual
Prefix:
First Name:KATHLYN
Middle Name:R
Last Name:BREWINGTON
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701837
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-1837
Mailing Address - Country:US
Mailing Address - Phone:972-800-4466
Mailing Address - Fax:214-377-4244
Practice Address - Street 1:16220 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4214
Practice Address - Country:US
Practice Address - Phone:972-800-4466
Practice Address - Fax:214-377-4244
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist