Provider Demographics
NPI:1063695674
Name:ROMAN, KATHRYN MARIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 ALLEN ST
Mailing Address - Street 2:A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1817
Mailing Address - Country:US
Mailing Address - Phone:413-783-5500
Mailing Address - Fax:413-782-7612
Practice Address - Street 1:1506 ALLEN ST
Practice Address - Street 2:A
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1817
Practice Address - Country:US
Practice Address - Phone:413-783-5500
Practice Address - Fax:413-782-7612
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12076580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist