Provider Demographics
NPI:1205963055
Name:HARRISON, KATHLEEN M (SLP 3063)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:HARRISON
Suffix:
Gender:F
Credentials:SLP 3063
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-3063
Mailing Address - Street 1:7398 PRESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5705
Mailing Address - Country:US
Mailing Address - Phone:440-255-6518
Mailing Address - Fax:
Practice Address - Street 1:4553 HINCKLEY INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-6009
Practice Address - Country:US
Practice Address - Phone:216-299-9643
Practice Address - Fax:216-635-3530
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSLP3063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist