Basic Information
Provider Information
NPI: 1568839074
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALTERS
FirstName: KATHRYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10000 W. 75TH ST.
Address2: STE. 250
City: MERRIAM
State: KS
PostalCode: 66204
CountryCode: US
TelephoneNumber: 8889131910
FaxNumber:  
Practice Location
Address1: 10000 W 75TH ST
Address2: STE. 250
City: MERRIAM
State: KS
PostalCode: 662042209
CountryCode: US
TelephoneNumber: 8889131910
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2015
LastUpdateDate: 09/01/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X3861KSY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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