Healthcare Provider Details

I. General information

NPI: 1689596264
Provider Name (Legal Business Name): KATIE L KOLSTAD CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11872 WEMBLEY RD
LOS ALAMITOS CA
90720-4436
US

IV. Provider business mailing address

11872 WEMBLEY RD
LOS ALAMITOS CA
90720-4436
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-4580
  • Fax:
Mailing address:
  • Phone: 562-799-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: