MEDICARE: KATHLEEN DEERING CCC-SP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 2982	OH

General Provider Information

NPI Number	:	1154679900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN DEERING CCC-SP

Provider Business Mailing Address
First Line	:	61 N CLEVELAND MASSILLON RD
Second Line	:	SUITE B
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-4558
Country	:	US
Telephone Number	:	330-668-4041
Fax Number	:	330-666-5626

Provider Business Practice Location Address
First Line	:	3428 W MARKET ST
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3339
Country	:	US
Telephone Number	:	330-668-4041
Fax Number	:	330-666-5626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	01/20/2018

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Directions to “ KATHLEEN DEERING CCC-SP” Practice Location

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