Provider Demographics
NPI:1750794442
Name:CHIU, KATHRYN (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CHIU
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W END AVE APT 28S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5552
Mailing Address - Country:US
Mailing Address - Phone:336-847-6171
Mailing Address - Fax:
Practice Address - Street 1:185 W END AVE APT 28S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5552
Practice Address - Country:US
Practice Address - Phone:336-847-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY024683-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program