Provider Demographics
NPI:1720533946
Name:KAMOLNICK, PINA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PINA
Middle Name:
Last Name:KAMOLNICK
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 1:1040 NOBEL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2357
Mailing Address - Country:US
Mailing Address - Phone:831-421-2599
Mailing Address - Fax:831-515-5088
Practice Address - Street 1:1040 NOBEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2357
Practice Address - Country:US
Practice Address - Phone:831-421-2599
Practice Address - Fax:831-515-5088
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 7916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist