Provider Demographics
NPI:1164181814
Name:KATSUYAMA, JESSICA ROSE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROSE
Last Name:KATSUYAMA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4074
Mailing Address - Country:US
Mailing Address - Phone:818-265-9515
Mailing Address - Fax:
Practice Address - Street 1:1505 WILSON TER STE 220
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4074
Practice Address - Country:US
Practice Address - Phone:818-265-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3676231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist