Provider Demographics
NPI:1427607167
Name:KOLT, STRAWBERRY FAWN (HIS)
Entity Type:Individual
Prefix:
First Name:STRAWBERRY
Middle Name:FAWN
Last Name:KOLT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23822 VALENCIA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5303
Mailing Address - Country:US
Mailing Address - Phone:661-253-3277
Mailing Address - Fax:
Practice Address - Street 1:23822 VALENCIA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5303
Practice Address - Country:US
Practice Address - Phone:661-253-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8195237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist