Provider Demographics
NPI:1679698732
Name:PEREZ, KATHERINE CANDLAND (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CANDLAND
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:500 W. WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-636-3910
Mailing Address - Fax:479-202-9100
Practice Address - Street 1:2100 WEST PERRY RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-631-3515
Practice Address - Fax:479-202-9105
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4343235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ581274OtherAHCCCS ID