Provider Demographics
NPI:1053893156
Name:PONTIUS, KATHRYN JOY
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOY
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 MARTINSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9504
Mailing Address - Country:US
Mailing Address - Phone:740-393-5970
Mailing Address - Fax:
Practice Address - Street 1:300 NEWARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4510
Practice Address - Country:US
Practice Address - Phone:740-397-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13568235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist