Provider Demographics
NPI:1255667051
Name:ATANASOVA, KATERINA NIKOLAEVA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATERINA
Middle Name:NIKOLAEVA
Last Name:ATANASOVA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 CROWNTREE LN APT 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8048
Mailing Address - Country:US
Mailing Address - Phone:407-222-2522
Mailing Address - Fax:
Practice Address - Street 1:320 DUNDAS DR STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5591
Practice Address - Country:US
Practice Address - Phone:904-757-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist