Provider Demographics
NPI:1861848822
Name:HARDIN, KATHLEEN C (SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:HARDIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W JEFFERSON BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5087
Mailing Address - Country:US
Mailing Address - Phone:214-646-1570
Mailing Address - Fax:214-865-6644
Practice Address - Street 1:1005 W JEFFERSON BLVD
Practice Address - Street 2:STE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5087
Practice Address - Country:US
Practice Address - Phone:214-646-1570
Practice Address - Fax:214-865-6644
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110443Other110443