Provider Demographics
NPI:1255665345
Name:AMOS, KATHLEEN LOUISE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:AMOS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:LOUISE
Other - Last Name:SMITH-AMOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:1399 YGNACIO VALLEY RD STE 36
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2815
Mailing Address - Country:US
Mailing Address - Phone:925-326-4040
Mailing Address - Fax:925-464-7682
Practice Address - Street 1:1399 YGNACIO VALLEY RD STE 36
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2815
Practice Address - Country:US
Practice Address - Phone:925-326-4040
Practice Address - Fax:925-891-9113
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1946231H00000X
CAHA3050237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist