Provider Demographics
NPI:1083116727
Name:ANAWALT, KATHARINE D (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:D
Last Name:ANAWALT
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 1:3410 DESCANSO DR APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2743
Mailing Address - Country:US
Mailing Address - Phone:626-222-2119
Mailing Address - Fax:
Practice Address - Street 1:3410 DESCANSO DR APT 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2743
Practice Address - Country:US
Practice Address - Phone:626-222-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist