Provider Demographics
NPI:1912383878
Name:LIN, KATHERINE AGNES
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AGNES
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:AGNES
Other - Last Name:TOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8303 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-4357
Mailing Address - Country:US
Mailing Address - Phone:626-512-3123
Mailing Address - Fax:
Practice Address - Street 1:301 E FOOTHILL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2551
Practice Address - Country:US
Practice Address - Phone:833-319-3969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9859235Z00000X
CA24157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist