Provider Demographics
NPI:1154565844
Name:COWBURN, KACEY BETH (SLP)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:BETH
Last Name:COWBURN
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 1:270 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2052
Mailing Address - Country:US
Mailing Address - Phone:724-349-5070
Mailing Address - Fax:724-349-8368
Practice Address - Street 1:270 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2052
Practice Address - Country:US
Practice Address - Phone:724-349-5070
Practice Address - Fax:724-349-8368
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist