Individual
MISS KATHLEEN S FOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
751 ROUTE 73 N, MARLTON, NJ 08053-3463
(856) 375-2914
Mailing address
116 BURGUNDY CT, WENONAH, NJ 08090-2032
(856) 693-1325
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00794300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14110145
ASHA CERTIFICAT OF CLINICAL COMPETENCE
NJ
01
—
41YS00794300
STATE OF NEW JERSEY DIVISION OF CONSUMER AFFAIRS
NJ
Enumeration date
04/24/2019
Last updated
04/24/2019
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