Healthcare Provider Details

I. General information

NPI: 1336320589
Provider Name (Legal Business Name): KATHLEEN ANNE HARLAN M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANNE JANES M.A., CCC-A

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD STE 600
LOS ANGELES CA
90025-6807
US

IV. Provider business mailing address

11645 WILSHIRE BLVD SUITE 600
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-5558
  • Fax: 310-477-7281
Mailing address:
  • Phone: 310-477-5558
  • Fax: 310-477-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU 1462
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: