Provider Demographics
NPI:1003292426
Name:KATSUYAMA, YVONNE (, MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:KATSUYAMA
Suffix:
Gender:F
Credentials:, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 CROSSINGS DR STE 102-359
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3932
Mailing Address - Country:US
Mailing Address - Phone:916-276-0823
Mailing Address - Fax:
Practice Address - Street 1:1700 EUREKA RD STE 155
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7786
Practice Address - Country:US
Practice Address - Phone:916-276-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 20763235Z00000X
CASP20763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty