Individual
MRS. KATHLEEN ELLEN DERGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MACCC/SLP
Contact information
Practice address
435 W LIBERTY ST, MEDINA, OH 44256-2221
(216) 749-6650
(330) 723-8920
Mailing address
5000 ROCKSIDE RD STE 500, INDEPENDENCE, OH 44131-2178
(216) 459-2846
(216) 901-2803
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP.02499
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0148011
—
OH
01
—
11658102
CAQH
OH
Enumeration date
04/11/2006
Last updated
11/06/2019
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