Provider Demographics
NPI:1417228057
Name:URQUICO, KATHERYN J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:J
Last Name:URQUICO
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 1:7910 MENCKEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-6126
Mailing Address - Country:US
Mailing Address - Phone:818-309-9321
Mailing Address - Fax:
Practice Address - Street 1:7910 MENCKEN AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-6126
Practice Address - Country:US
Practice Address - Phone:818-309-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist