Provider Demographics
NPI:1609091834
Name:BROESAMLE, KATHARINE
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BROESAMLE
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 1:3945 THACHER RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-9368
Mailing Address - Country:US
Mailing Address - Phone:805-646-5948
Mailing Address - Fax:
Practice Address - Street 1:3945 THACHER RD
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-9368
Practice Address - Country:US
Practice Address - Phone:805-646-5948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP0059580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist