Provider Demographics
NPI:1033469895
Name:MIKHAILOV, KATHERINE CLAIRE (AUD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CLAIRE
Last Name:MIKHAILOV
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 40TH ST
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3616
Mailing Address - Country:US
Mailing Address - Phone:212-354-2360
Mailing Address - Fax:
Practice Address - Street 1:110 W 40TH ST
Practice Address - Street 2:SUITE 1403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3616
Practice Address - Country:US
Practice Address - Phone:212-354-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57002434231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist