Provider Demographics
NPI:1891427951
Name:PHELPS, KATHERINE MEGAN (SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MEGAN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MEGAN
Other - Last Name:GWOZDZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:341 LEE HOOK RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-4417
Mailing Address - Country:US
Mailing Address - Phone:703-489-9605
Mailing Address - Fax:
Practice Address - Street 1:46 BARRA RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9459
Practice Address - Country:US
Practice Address - Phone:207-282-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST3720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist