Provider Demographics
NPI:1780957753
Name:DEROCHE, KATHY ANN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANN
Last Name:DEROCHE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 PROSPECT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-8564
Mailing Address - Country:US
Mailing Address - Phone:704-984-5252
Mailing Address - Fax:704-984-5252
Practice Address - Street 1:419 PROSPECT CHURCH RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8564
Practice Address - Country:US
Practice Address - Phone:704-984-5252
Practice Address - Fax:704-984-5252
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist