Healthcare Provider Details

I. General information

NPI: 1447470208
Provider Name (Legal Business Name): KATHERINE ROSE GARCIA MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KATHERINE ROSE FUEMMELER

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8766 E HWY 69 HUMBOLDT UNIFIED SCHOOL DISTRICT #22 SPECIAL SERVICES
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

8766 E HWY 69 HUMBOLDT UNIFIED SCHOOL DISTRICT SPECIAL SERVICES OFFIC
PRESCOTT VALLEY AZ
86314
US

V. Phone/Fax

Practice location:
  • Phone: 928-759-4028
  • Fax: 928-759-4030
Mailing address:
  • Phone: 928-759-4028
  • Fax: 928-759-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP2107
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: