1164630646 NPI number — MRS. KATHLEEN EVELYN PEARSON SLP

Table of content: MRS. KATHLEEN EVELYN PEARSON SLP (NPI 1164630646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164630646 NPI number — MRS. KATHLEEN EVELYN PEARSON SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
KATHLEEN
Provider Middle Name:
EVELYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMILTON
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
EVELYN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164630646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 W 11TH ST
Provider Second Line Business Mailing Address:
SUITE 402
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16501-1758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-464-0629
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 W 11TH ST
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16501-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-464-0629
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2007

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:  SL002748L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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