Provider Demographics
NPI:1932517661
Name:ALBA, KATHRYN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:ALBA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RACETRACK RD NE STE E4
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1867
Mailing Address - Country:US
Mailing Address - Phone:850-315-4141
Mailing Address - Fax:850-226-8242
Practice Address - Street 1:11 RACETRACK RD NE STE E4
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1867
Practice Address - Country:US
Practice Address - Phone:850-315-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01688231H00000X
FLAY1958231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist