Provider Demographics
NPI:1669780193
Name:BRIEN, KATHERINE M (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:BRIEN
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 1:116 WEST ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2208
Mailing Address - Country:US
Mailing Address - Phone:315-895-0320
Mailing Address - Fax:
Practice Address - Street 1:116 WEST ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-2208
Practice Address - Country:US
Practice Address - Phone:315-895-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016001-1235Z00000X
NY794156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist