Provider Demographics
NPI:1720772130
Name:SIU, KATHRYN JIN (AUD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JIN
Last Name:SIU
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NORWAY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-3198
Mailing Address - Country:US
Mailing Address - Phone:413-567-0374
Mailing Address - Fax:
Practice Address - Street 1:32 NORWAY ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-3198
Practice Address - Country:US
Practice Address - Phone:413-567-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAUD100051237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter