Basic Information
| Provider Information | |||||||||
| NPI: | 1689708893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLANTYNE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | READ | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 EDDY STREET | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015339100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 VALLEY STREAM DR | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028645045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013390930 | ||||||||
| FaxNumber: | 4013340011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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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 | SP00259 | RI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 2092 | 01 | RI | EI NHPRC | OTHER | 292177 | 01 | RI | EI BCROSS | OTHER | 412296 | 01 | RI | EI BCHIP | OTHER | 4600103 | 01 | RI | EI UNITED | OTHER |