Healthcare Provider Details

I. General information

NPI: 1780474080
Provider Name (Legal Business Name): KATHLEEN LEPAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E WILSON BRIDGE RD
WORTHINGTON OH
43085-2327
US

IV. Provider business mailing address

988 KENMORE XING UNIT 108
MARYSVILLE OH
43040-7170
US

V. Phone/Fax

Practice location:
  • Phone: 614-681-1030
  • Fax:
Mailing address:
  • Phone: 973-464-4537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.16367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: