Healthcare Provider Details

I. General information

NPI: 1225652688
Provider Name (Legal Business Name): KATHLEEN ANN GRIFFITH MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD STE 150
KIRKWOOD MO
63122-7251
US

IV. Provider business mailing address

1001 S KIRKWOOD RD STE 150
KIRKWOOD MO
63122-7251
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax:
Mailing address:
  • Phone: 314-821-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2013010099
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: