Provider Demographics
NPI:1649033697
Name:KAFOURE, DORY R (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DORY
Middle Name:R
Last Name:KAFOURE
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 1:18153 SUN MAIDEN CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3102
Mailing Address - Country:US
Mailing Address - Phone:858-722-4127
Mailing Address - Fax:
Practice Address - Street 1:18153 SUN MAIDEN CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3102
Practice Address - Country:US
Practice Address - Phone:858-722-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty