Provider Demographics
NPI:1073145405
Name:KOCHANOWSKI, KATRINA PAIGE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:PAIGE
Last Name:KOCHANOWSKI
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 1:8792 LAUDER CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2222
Mailing Address - Country:US
Mailing Address - Phone:714-465-0785
Mailing Address - Fax:
Practice Address - Street 1:16200 VENTURA BLVD STE 203C
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4636
Practice Address - Country:US
Practice Address - Phone:818-941-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant