1205169505 NPI number — MS. KATHRYN ANNE WEISS CCC-SLP

Table of content: MS. KATHRYN ANNE WEISS CCC-SLP (NPI 1205169505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205169505 NPI number — MS. KATHRYN ANNE WEISS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
KATHRYN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'CONNELL
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205169505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 CHANNING PL
Provider Second Line Business Mailing Address:
APT 1L
Provider Business Mailing Address City Name:
EASTCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10709-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-787-9404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CHANNING PL
Provider Second Line Business Practice Location Address:
APT 1L
Provider Business Practice Location Address City Name:
EASTCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10709-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-787-9404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  091200 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019200 . This is a "NY STATE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12081507 . This is a "AMERICAN SPEECH AND HEARING ASSOCIATION (ASHA)" identifier . This identifiers is of the category "OTHER".