Provider Demographics
NPI:1255756151
Name:SEARS, KATHY ANNE (SLP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANNE
Last Name:SEARS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 S CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2716
Mailing Address - Country:US
Mailing Address - Phone:417-839-1916
Mailing Address - Fax:
Practice Address - Street 1:907 S CRAIG AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2716
Practice Address - Country:US
Practice Address - Phone:417-839-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist