Provider Demographics
NPI:1992048268
Name:SHAFER, KATHRYN K (SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:K
Last Name:SHAFER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:K
Other - Last Name:KOWALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4120 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1060
Mailing Address - Country:US
Mailing Address - Phone:308-380-6590
Mailing Address - Fax:
Practice Address - Street 1:4120 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1060
Practice Address - Country:US
Practice Address - Phone:308-380-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist