Provider Demographics
NPI:1306158837
Name:EGAN, KATHERINE (MS, SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BOBRICK RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5108
Mailing Address - Country:US
Mailing Address - Phone:845-625-9581
Mailing Address - Fax:
Practice Address - Street 1:4885 ROUTE 9
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580-6028
Practice Address - Country:US
Practice Address - Phone:845-889-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist