Basic Information
| Provider Information | |||||||||
| NPI: | 1750634085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURHAM | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | ANN | ||||||||
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| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | KATHRYN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2604 S MADISON ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724015905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709320090 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2604 S MADISON ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724015905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709320090 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2012 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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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 | SP#P8527 | AR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.