Provider Demographics
NPI:1851522312
Name:PATRICIA KOOREN, SPEECH THERAPIST
Entity Type:Organization
Organization Name:PATRICIA KOOREN, SPEECH THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:KOOREN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:858-805-1519
Mailing Address - Street 1:11350 SWAN CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3538
Mailing Address - Country:US
Mailing Address - Phone:858-805-1519
Mailing Address - Fax:858-536-8123
Practice Address - Street 1:11350 SWAN CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3538
Practice Address - Country:US
Practice Address - Phone:858-805-1519
Practice Address - Fax:858-536-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty