Provider Demographics
NPI:1932447083
Name:KISS, REKA T (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:REKA
Middle Name:T
Last Name:KISS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E. PALM
Mailing Address - Street 2:APT C
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3341
Mailing Address - Country:US
Mailing Address - Phone:207-756-3557
Mailing Address - Fax:
Practice Address - Street 1:716 E. PALM
Practice Address - Street 2:APT C
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3341
Practice Address - Country:US
Practice Address - Phone:207-756-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA21002355S0801X
CA21943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant