Provider Demographics
NPI:1245642933
Name:TOBIAS, KATHLEEN (MA CCC-SPEECH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:MA CCC-SPEECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13244 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8429
Mailing Address - Country:US
Mailing Address - Phone:330-877-4292
Mailing Address - Fax:
Practice Address - Street 1:13244 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8429
Practice Address - Country:US
Practice Address - Phone:330-877-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3448Medicaid