| Doctor Name: | MRS. KATHLEEN ELLEN DERGA |
| NPI Number: | 1174586838 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MACCC/SLP |
| License Number: | SP2499 |
| Business Practice Address: | 5000 Rockside Rd Ste 500 Independence, OH - 441312178 |
| Business Phone Number: | 2164592846 |
| Business Fax Number: | 2169012803 |
| Mailing Address: | 855 Woodhaven Ln, MEDINA |
| State: | OH |
| Postal Code: | 442561201 |
| Phone Number: | 3307222035 |
| Fax Number: | 3307234530 |
| NPI Enumeration Date: | 04/11/2006 |
| NPI Last Update Date: | 11/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP2499 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |