Provider Demographics
NPI:1043714348
Name:PISCITELLI, KATJA ROSE
Entity Type:Individual
Prefix:
First Name:KATJA
Middle Name:ROSE
Last Name:PISCITELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7453 WINDBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4703
Mailing Address - Country:US
Mailing Address - Phone:218-750-4319
Mailing Address - Fax:
Practice Address - Street 1:7453 WINDBRIDGE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-4703
Practice Address - Country:US
Practice Address - Phone:218-750-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist