Provider Demographics
NPI:1871713297
Name:FITZGERALD, KATHLEEN LYNNE (MS CCCSLP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LYNNE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
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Mailing Address - Street 1:52 BRIGHAM STREET SUITE 4
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740
Mailing Address - Country:US
Mailing Address - Phone:508-991-2332
Mailing Address - Fax:508-991-8437
Practice Address - Street 1:52 BRIGHAM STREET SUITE 4
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-991-2332
Practice Address - Fax:508-991-8437
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3875235Z00000X
RISP00530235Z00000X
CT003635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist