Provider Demographics
NPI:1780185645
Name:WALLISCH, KATHERINE HANTA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HANTA
Last Name:WALLISCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:HANTA
Other - Last Name:WALLISCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:10300 W CHARLESTON BLVD, SUITE 13-J19
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-316-4826
Practice Address - Street 1:9260 W SUNSET RD STE 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-355-9862
Practice Address - Fax:888-316-4826
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CA2400X, 261QA3000X
NVSP-2267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology PractitionerGroup - Single Specialty
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication