Provider Demographics
NPI:1699048884
Name:CHASE, KATHLEEN MALLORY (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MALLORY
Last Name:CHASE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ELIZA
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4993 E GEDDES CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2449
Mailing Address - Country:US
Mailing Address - Phone:720-339-8164
Mailing Address - Fax:720-488-0765
Practice Address - Street 1:4993 E GEDDES CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2449
Practice Address - Country:US
Practice Address - Phone:720-339-8164
Practice Address - Fax:720-488-0765
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCCC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist