Healthcare Provider Details

I. General information

NPI: 1184871915
Provider Name (Legal Business Name): KAREN ANN KOCHIS-JENNINGS CCC - SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 HYPERION AVE
LOS ANGELES CA
90027-4705
US

IV. Provider business mailing address

2019 HYPERION AVE
LOS ANGELES CA
90027-4705
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-1758
  • Fax:
Mailing address:
  • Phone: 323-644-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: