Provider Demographics
NPI:1457538589
Name:WALSH, KATHY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3781
Mailing Address - Country:US
Mailing Address - Phone:510-451-5800
Mailing Address - Fax:
Practice Address - Street 1:150 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3781
Practice Address - Country:US
Practice Address - Phone:510-451-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CASP 11196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist