Provider Demographics
NPI:1275287161
Name:KUCHARAU, VALERIYA (SLP)
Entity Type:Individual
Prefix:
First Name:VALERIYA
Middle Name:
Last Name:KUCHARAU
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:VALERIYA
Other - Middle Name:
Other - Last Name:FEDOROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1301 E. BIDWELL STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3565
Mailing Address - Country:US
Mailing Address - Phone:916-983-5915
Mailing Address - Fax:916-983-5906
Practice Address - Street 1:1301 E BIDWELL ST STE 202
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3565
Practice Address - Country:US
Practice Address - Phone:916-983-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15434235Z00000X
CA33042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15434OtherLICENSE