Provider Demographics
NPI:1821608670
Name:NORTH STAR SPEECH AND LANGUAGE PATHOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:NORTH STAR SPEECH AND LANGUAGE PATHOLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD, CCC-SLP
Authorized Official - Phone:619-436-1187
Mailing Address - Street 1:4624 W POINT LOMA BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1441
Mailing Address - Country:US
Mailing Address - Phone:619-436-1187
Mailing Address - Fax:
Practice Address - Street 1:2801 CAMINO DEL RIO S STE 302
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3860
Practice Address - Country:US
Practice Address - Phone:619-436-1187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174281349OtherNPI
1750831715OtherNPI