Provider Demographics
NPI:1689140006
Name:MCDONOUGH, KATHERINE JOAN JOHNSTON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOAN JOHNSTON
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JOAN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1049 EL MONTE AVE STE C185
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2398
Mailing Address - Country:US
Mailing Address - Phone:408-409-5161
Mailing Address - Fax:
Practice Address - Street 1:1049 EL MONTE AVE STE C185
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2398
Practice Address - Country:US
Practice Address - Phone:408-409-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist