Provider Demographics
NPI:1932853389
Name:SHAW, KATHY (HIS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH AVE W STE 2
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2749
Mailing Address - Country:US
Mailing Address - Phone:641-673-0911
Mailing Address - Fax:563-726-7383
Practice Address - Street 1:200 HIGH AVE W STE 2
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2749
Practice Address - Country:US
Practice Address - Phone:641-673-0911
Practice Address - Fax:563-726-7383
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA904237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist