Provider Demographics
NPI:1912145756
Name:GOVERSKI, KATHLEEN STACEY (M S CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:STACEY
Last Name:GOVERSKI
Suffix:
Gender:F
Credentials:M S CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BATTERY BLVD
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3366
Mailing Address - Country:US
Mailing Address - Phone:518-664-7406
Mailing Address - Fax:
Practice Address - Street 1:39 BATTERY BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-3366
Practice Address - Country:US
Practice Address - Phone:518-664-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist