Provider Demographics
NPI:1174704431
Name:PHILLIPS, KATHLEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 E VALLEY WATER MILL RD
Mailing Address - Street 2:APT. 4804
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4908
Mailing Address - Country:US
Mailing Address - Phone:417-380-4057
Mailing Address - Fax:
Practice Address - Street 1:3126 E VALLEY WATER MILL RD
Practice Address - Street 2:APT 4804
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4908
Practice Address - Country:US
Practice Address - Phone:417-833-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19282235Z00000X
MO2008016779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist