Provider Demographics
NPI:1902925985
Name:CARNEY, KATHLEEN ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:CARNEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-2250
Mailing Address - Country:US
Mailing Address - Phone:610-459-9719
Mailing Address - Fax:610-358-2832
Practice Address - Street 1:22 MAPLE LN
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-2250
Practice Address - Country:US
Practice Address - Phone:610-459-9719
Practice Address - Fax:610-358-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005404L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018856800001OtherMEDICAL ASSISTANCE