Basic Information
| Provider Information | |||||||||
| NPI: | 1417236340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERTIG | ||||||||
| FirstName: | KATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1438 TAYLORSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17921 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 TAYLORSVILLE MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | PITMAN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179649104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706440489 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2011 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.