MEDICARE: KATHERINE SIMONITCH 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	103944	TX
2	235Z00000X	Speech-Language Pathologist	27823	CA

General Provider Information

NPI Number	:	1467861518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SIMONITCH CCC-SLP

Provider Business Mailing Address
First Line	:	41555 COOK ST STE 130
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-5184
Country	:	US
Telephone Number	:	760-837-0033
Fax Number	:	760-837-1013

Provider Business Practice Location Address
First Line	:	41555 COOK ST STE 130
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-5184
Country	:	US
Telephone Number	:	760-837-0033
Fax Number	:	760-837-1013

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

Provider Enumeration Date	:	08/02/2014
Last Update Date	:	10/12/2020

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Directions to “ KATHERINE SIMONITCH CCC-SLP” Practice Location

Language	Start Address	Practice Location

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