Basic Information
| Provider Information | |||||||||
| NPI: | 1003293044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROSS | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3981 COVENTRY DR | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995073319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077173077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12350 INDUSTRY WAY | ||||||||
| Address2: | 202 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995154300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073014588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2015 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 551 | AK | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.