Provider Demographics
NPI:1730623935
Name:POTTER, KATHY LYNN I (MS)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LYNN
Last Name:POTTER
Suffix:I
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:SCHEUERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:6015 HAZEL WAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4271
Mailing Address - Country:US
Mailing Address - Phone:530-228-7818
Mailing Address - Fax:530-087-5124
Practice Address - Street 1:6015 HAZEL WAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4271
Practice Address - Country:US
Practice Address - Phone:530-228-7818
Practice Address - Fax:530-876-1244
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist