Provider Demographics
NPI:1043585086
Name:ENGEL, KATHRYN L (MS, CCC-SLP, CBIS)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:ENGEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:MCCLOCKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6518 CLAYTON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3321
Mailing Address - Country:US
Mailing Address - Phone:314-560-0500
Mailing Address - Fax:
Practice Address - Street 1:4455 DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1111
Practice Address - Country:US
Practice Address - Phone:314-658-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011007235Z00000X
283X00000X
MO2009001613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No283X00000XHospitalsRehabilitation Hospital