Provider Demographics
NPI:1942446521
Name:CARNEY, KATHLEEN MARY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:CARNEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 VENETO CIR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2454
Mailing Address - Country:US
Mailing Address - Phone:530-343-8975
Mailing Address - Fax:
Practice Address - Street 1:71 VENETO CIR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2454
Practice Address - Country:US
Practice Address - Phone:530-343-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15961235Z00000X
NY003731-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist