Provider Demographics
NPI:1952714776
Name:MCKERNAN, KATHERINE (SLPD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:MCKERNAN
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 W POINT LOMA BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1441
Mailing Address - Country:US
Mailing Address - Phone:619-436-1187
Mailing Address - Fax:
Practice Address - Street 1:4624 W POINT LOMA BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1441
Practice Address - Country:US
Practice Address - Phone:619-436-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist