MEDICARE: KATHLEEN WALSH CCC-SLP

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	19565	CA
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1457694168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN WALSH CCC-SLP

Provider Business Mailing Address
First Line	:	5540 FOREST GLEN DR
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-5631
Country	:	US
Telephone Number	:	317-431-6224
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 FOREST GLEN DR
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-5631
Country	:	US
Telephone Number	:	317-431-6224
Fax Number	:

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	10/04/2022

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Directions to “ KATHLEEN WALSH CCC-SLP” Practice Location

Language	Start Address	Practice Location

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