Provider Demographics
NPI:1972129732
Name:LERNER, KATHRYN C (SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:C
Last Name:LERNER
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 1:2704 N OAK ST
Mailing Address - Street 2:BLDG A2
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5900
Mailing Address - Country:US
Mailing Address - Phone:229-253-1009
Mailing Address - Fax:229-253-1039
Practice Address - Street 1:2704 N OAK ST BLDG A2
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5900
Practice Address - Country:US
Practice Address - Phone:229-253-1009
Practice Address - Fax:229-253-1039
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003081235Z00000X
GASLP011497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP011497OtherGA LICENSE