Provider Demographics
NPI:1194891622
Name:WEBSTER, KATHY LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LYNN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:31320 INTERSTATE 10 W
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9238
Mailing Address - Country:US
Mailing Address - Phone:830-755-8853
Mailing Address - Fax:830-755-8875
Practice Address - Street 1:31320 INTERSTATE 10 W
Practice Address - Street 2:SUITE D
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9238
Practice Address - Country:US
Practice Address - Phone:830-755-8853
Practice Address - Fax:830-755-8875
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87771TOtherBLUE CROSS BLUE SHIELD
TX1832651-01Medicaid