Healthcare Provider Details

I. General information

NPI: 1881285054
Provider Name (Legal Business Name): KATHERINE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WAKEFIELD ST SUITE 8
ROCHESTER NH
03867
US

IV. Provider business mailing address

806 NORTH MAIN STREET BOOTHBY THERAPY SERVICES
LACONIA NH
03246
US

V. Phone/Fax

Practice location:
  • Phone: 603-335-3617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: