Individual provider Active NPI

Kevin Blaine Lathrop, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Rocky Hill, CT
National Provider Identifier
1356550255
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
003261 Issued in CT
Practice address
2 Knoll LN
Rocky Hill, CT 06067-4241
Phone
(860) 836-3317
Fax
(860) 571-9347
NPI assigned
May 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 003261 CT Primary

Addresses

Primary practice location

2 Knoll LN
Rocky Hill, CT 06067-4241

Mailing address

2 Knoll LN
Rocky Hill, CT 06067-4241
Phone (860) 836-3317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240113000410 OK Practitioner - Qualified Speech Language Pathologist 4880046994 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
003261CTMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Dec 3, 2023 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince Dec 3, 2023 Accepting new patients

Locations

4950 Thunderbird Dr
Boulder, CO 80303
Phone (303) 499-4888

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356550255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 KNOLL LN",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060674241",
            "telephone_number": "860-836-3317",
            "fax_number": "860-571-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 KNOLL LN",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060674241",
            "telephone_number": "860-836-3317",
            "fax_number": "860-571-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHROP",
        "first_name": "KEVIN",
        "middle_name": "BLAINE",
        "name_prefix": "Mr.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "003261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Hill, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.