Provider Demographics
NPI:1467012005
Name:HERRERA, KATHERINE ROSE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-2189
Mailing Address - Country:US
Mailing Address - Phone:928-287-5492
Mailing Address - Fax:
Practice Address - Street 1:748 E PATRICIA ST.
Practice Address - Street 2:748 E. PATRICIA ST.
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-2189
Practice Address - Country:US
Practice Address - Phone:928-287-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA118772355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant