Provider Demographics
NPI:1053928937
Name:HERBERT, KATHERINE (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 WOONASQUATUCKET AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-7119
Mailing Address - Country:US
Mailing Address - Phone:708-738-4409
Mailing Address - Fax:
Practice Address - Street 1:15 SUMNER BROWN RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1214
Practice Address - Country:US
Practice Address - Phone:401-333-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist