Provider Demographics
NPI:1962797241
Name:DALTRY, KATHRYN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DALTRY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 PENINSULA GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-3055
Mailing Address - Country:US
Mailing Address - Phone:281-812-9519
Mailing Address - Fax:
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY
Practice Address - Street 2:104
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5138
Practice Address - Country:US
Practice Address - Phone:281-812-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105838235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist