Kathleen Ellen Derga, MACCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP.02499 Issued in OH

Practice address

435 W Liberty St
Medina, OH 44256-2221

Phone

(216) 749-6650

Fax

(330) 723-8920

NPI assigned

Apr 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572998400000",
    "number": "1174586838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 ROCKSIDE RD STE 500",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312178",
            "telephone_number": "216-459-2846",
            "fax_number": "216-901-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 W LIBERTY ST",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562221",
            "telephone_number": "216-749-6650",
            "fax_number": "330-723-8920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERGA",
        "first_name": "KATHLEEN",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "MACCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2019-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP.02499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0148011",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11658102",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals Cleveland - Nouneh, Inc.
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• Stephen Douglas Depp
• Tammy Depriest
• Kriszti R Derga
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• Lisa Webb Derrick, M.D.
• Deborah Daline Detmayer
• Kate Deville, PT, DPT

• Speech-Language Pathologist in Medina, OH
• Providers in Medina, OH by specialty
• Speech-Language Pathologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.