Provider Demographics
NPI:1669711024
Name:GAPPA, KATORIA L (HIS)
Entity type:Individual
Prefix:
First Name:KATORIA
Middle Name:L
Last Name:GAPPA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 GALLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3467
Mailing Address - Country:US
Mailing Address - Phone:715-831-8966
Mailing Address - Fax:715-831-8968
Practice Address - Street 1:618 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9232
Practice Address - Country:US
Practice Address - Phone:608-355-0555
Practice Address - Fax:608-355-0556
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1410-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist