Provider Demographics
NPI:1598724205
Name:WONG, KATHRYN P (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:P
Last Name:WONG
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 1:912 RICH AVE
Mailing Address - Street 2:APT. #3
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2472
Mailing Address - Country:US
Mailing Address - Phone:650-245-7170
Mailing Address - Fax:
Practice Address - Street 1:4546 EL CAMINO REAL
Practice Address - Street 2:SUITE 218
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1099
Practice Address - Country:US
Practice Address - Phone:650-245-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2344108OtherUNITED HEALTHCARE
CA107984OtherHEALTH NET
CASP0101270OtherBLUE SHIELD OF CALIFORNIA