MEDICARE: MS. KATHLEEN ANN MUNROE MS, CCC-SLP, CBIS

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	19552	CA

General Provider Information

NPI Number	:	1538561519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN MUNROE MS, CCC-SLP, CBIS

Provider Business Mailing Address
First Line	:	1205 PACIFIC HIGHWAY
Second Line	:	2906
City	:	SAN DIEGO
State	:	CA
Zip	:	92101
Country	:	US
Telephone Number	:	619-822-3624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 PACIFIC HIGHWAY
Second Line	:	2906
City	:	SAN DIEGO
State	:	CA
Zip	:	92101
Country	:	US
Telephone Number	:	619-822-3624
Fax Number	:

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

Provider Enumeration Date	:	09/21/2014
Last Update Date	:	08/05/2022

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