Provider Demographics
NPI:1750524161
Name:DIBLASI, KATHLEEN D (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:DIBLASI
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 1:57 MCNEIR AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-2817
Mailing Address - Country:US
Mailing Address - Phone:518-842-5343
Mailing Address - Fax:
Practice Address - Street 1:57 MCNEIR AVE
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-2817
Practice Address - Country:US
Practice Address - Phone:518-842-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009617-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist