Provider Demographics
NPI:1992194633
Name:CALLANAN, KATHRYN
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:CALLANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:GIFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-1409
Mailing Address - Country:US
Mailing Address - Phone:573-346-9239
Mailing Address - Fax:573-346-9211
Practice Address - Street 1:119 SERVICE RD
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-9525
Practice Address - Country:US
Practice Address - Phone:573-346-9239
Practice Address - Fax:573-346-9211
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist