Provider Demographics
NPI:1447342639
Name:ATKINSON, KATHRYN BETH (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:BETH
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 CAMBRIDGE LN APT 6
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-7168
Mailing Address - Country:US
Mailing Address - Phone:989-854-2058
Mailing Address - Fax:
Practice Address - Street 1:5150 CAMBRIDGE LN APT 6
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-7168
Practice Address - Country:US
Practice Address - Phone:989-854-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIASHA 01008867235Z00000X
MI7101001354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40-4683793Medicaid
MI7101001354OtherSTATE OF MICHIGAN LICENSE
MIASHA 01008867OtherASHA NUMBER