=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598047987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHENECTADY CITY SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2011
-----------------------------------------------------
Last Update Date | 08/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 ELEANOR ST
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12306-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-370-8340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 EDUCATION DR
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12303-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-370-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. KATHLEEN M BALLARD
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 518-370-8340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------