Healthcare Provider Details

I. General information

NPI: 1275287161
Provider Name (Legal Business Name): VALERIYA KUCHARAU SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIYA FEDOROVA SLP

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 BALBOA BLVD STE 242
NORTHRIDGE CA
91325-3593
US

IV. Provider business mailing address

1301 E. BIDWELL STREET SUITE 201
FOLSOM CA
95630-3565
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 916-983-5915
  • Fax: 916-983-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15434
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: