Provider Demographics
NPI:1841631181
Name:SMITH, KATHARINE (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:12 LOCUST AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:MEDORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:76 RANDALL RD
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1509
Practice Address - Country:US
Practice Address - Phone:631-433-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022971-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist