Provider Demographics
NPI:1720400591
Name:NGUYEN, KATIE T (SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3084
Mailing Address - Country:US
Mailing Address - Phone:530-668-1010
Mailing Address - Fax:
Practice Address - Street 1:96 W MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3084
Practice Address - Country:US
Practice Address - Phone:530-668-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist