Provider Demographics
NPI:1245600097
Name:HENKA, KATELYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:HENKA
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 1:1110 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2139
Mailing Address - Country:US
Mailing Address - Phone:714-453-9323
Mailing Address - Fax:
Practice Address - Street 1:1110 E CHAPMAN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2139
Practice Address - Country:US
Practice Address - Phone:714-453-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist