Healthcare Provider Details

I. General information

NPI: 1124787726
Provider Name (Legal Business Name): KATELYN S. LUDDINE MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12061 BRIGHTON RIV UNIT 50
FOUNTAIN VALLEY CA
92708-1351
US

IV. Provider business mailing address

12061 BRIGHTON RIV UNIT 50
FOUNTAIN VALLEY CA
92708-1351
US

V. Phone/Fax

Practice location:
  • Phone: 714-263-6520
  • Fax:
Mailing address:
  • Phone: 714-263-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: