Basic Information
| Provider Information | |||||||||
| NPI: | 1881890853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLEHER | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | MAUREEN | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 OLD HOWELL RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296151969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283572016 | ||||||||
| FaxNumber: | 8283571098 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CULLOWHEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287239646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282277251 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 7752 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 561850178 | 01 | NC | FED TAX ID | OTHER | 561850178 | 01 | NC | AMA | OTHER | 14087706 | 05 | NC | MEDICAID |