Provider Demographics
NPI:1124273966
Name:VASSAR, KATHRYN M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:VASSAR
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 1:142 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-2936
Mailing Address - Country:US
Mailing Address - Phone:518-534-0602
Mailing Address - Fax:
Practice Address - Street 1:7242 ROUTE 9 STE 101
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7243
Practice Address - Country:US
Practice Address - Phone:518-536-3452
Practice Address - Fax:518-561-1558
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011107-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011107-1OtherNEW YORK STATE LICENSE NUMBER