Provider Demographics
NPI:1124475876
Name:KATO, COLLEEN A (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:KATO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:A
Other - Last Name:KATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:2800 FRANCENA CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-5608
Mailing Address - Country:US
Mailing Address - Phone:330-461-3723
Mailing Address - Fax:
Practice Address - Street 1:3140 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9411
Practice Address - Country:US
Practice Address - Phone:330-722-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist