Provider Demographics
NPI:1265637375
Name:POWELL, KATHY R (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:R
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1064
Mailing Address - Country:US
Mailing Address - Phone:412-741-4662
Mailing Address - Fax:
Practice Address - Street 1:1030 W STATE ST
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1338
Practice Address - Country:US
Practice Address - Phone:724-869-6300
Practice Address - Fax:724-869-6347
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003911L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist