Basic Information
| Provider Information | |||||||||
| NPI: | 1831119866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERMAN | ||||||||
| FirstName: | KATHIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MSCCC-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: | 1000 EDDY STREET | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015339100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | SP00400 | RI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 99947 | 01 | RI | SS BCROSS | OTHER | 4600103 | 01 | RI | SS UHP | OTHER | 2058 | 01 | RI | SS NHPRC | OTHER | 408268 | 01 | RI | BCHIP | OTHER |