MEDICARE: KATHERINE JOAN JOHNSTON MCDONOUGH 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	24628	CA

General Provider Information

NPI Number	:	1689140006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE JOAN JOHNSTON MCDONOUGH CCC-SLP

Provider Business Mailing Address
First Line	:	1049 EL MONTE AVE STE C185
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2398
Country	:	US
Telephone Number	:	408-409-5161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 EL MONTE AVE STE C185
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2398
Country	:	US
Telephone Number	:	408-409-5161
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	04/23/2021

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Directions to “ KATHERINE JOAN JOHNSTON MCDONOUGH CCC-SLP” Practice Location

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