Provider Demographics
NPI:1205092947
Name:REID, KATHLEEN G (MA,CCC-A)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:REID
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1315
Mailing Address - Country:US
Mailing Address - Phone:516-887-1948
Mailing Address - Fax:
Practice Address - Street 1:50 VINE ST
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1315
Practice Address - Country:US
Practice Address - Phone:516-887-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001228231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist