Provider Demographics
NPI:1265715023
Name:BOLTON, KATHLEEN MARIE
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871
Mailing Address - Country:US
Mailing Address - Phone:518-695-3255
Mailing Address - Fax:518-695-6491
Practice Address - Street 1:14-18 SPRING STREET
Practice Address - Street 2:SCHUYLERVILLE SCHOOLS
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871
Practice Address - Country:US
Practice Address - Phone:518-695-3255
Practice Address - Fax:518-695-6491
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist