Provider Demographics
NPI:1548338114
Name:OVERMYER, KATHRYN A (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:OVERMYER
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:HOLLAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067
Mailing Address - Country:US
Mailing Address - Phone:719-469-4953
Mailing Address - Fax:
Practice Address - Street 1:900 SOUTH 12TH STREET
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067
Practice Address - Country:US
Practice Address - Phone:719-254-4202
Practice Address - Fax:719-254-4202
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01088492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist