Individual
KATHRYN KAREN MANCEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
221 W BEAR LAKE RD NE, KALKASKA, MI 49646-8566
(612) 812-2174
Mailing address
221 W BEAR LAKE RD NE, KALKASKA, MI 49646-8566
(612) 812-2174
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
29293
CA
235Z00000X
Speech-Language Pathologist
SA16577
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-
NO OTHER NUMBERS
—
01
—
29293
SPEECH LANGUAGE PATHOLOGY LICENSE
CA
Enumeration date
11/12/2018
Last updated
07/10/2020
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