Healthcare Provider Details

I. General information

NPI: 1316515513
Provider Name (Legal Business Name): KATHRYN DENNISON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10B MADISON AVENUE EXT
ALBANY NY
12203-7314
US

IV. Provider business mailing address

15 PINE ST
GRANVILLE NY
12832-1111
US

V. Phone/Fax

Practice location:
  • Phone: 518-867-3061
  • Fax:
Mailing address:
  • Phone: 518-307-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number144.0134360PROV
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number144.0134715
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: