MEDICARE: KATHERYN J URQUICO M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 16140	CA

General Provider Information

NPI Number	:	1417228057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERYN J URQUICO M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	7910 MENCKEN AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-6126
Country	:	US
Telephone Number	:	818-309-9321
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 MENCKEN AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-6126
Country	:	US
Telephone Number	:	818-309-9321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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Directions to “ KATHERYN J URQUICO M.S. CCC-SLP” Practice Location

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