Provider Demographics
NPI:1841650512
Name:DRISCOLL, KATHERINE AMANDA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMANDA
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:AMANDA
Other - Last Name:MCINTIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6900 HALL ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9485
Mailing Address - Country:US
Mailing Address - Phone:419-867-5666
Mailing Address - Fax:
Practice Address - Street 1:1205 KING RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-2099
Practice Address - Country:US
Practice Address - Phone:419-867-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.12104OtherSLP