Healthcare Provider Details

I. General information

NPI: 1831725522
Provider Name (Legal Business Name): KATHLEEN ANN WINGER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6848 BONNIE VIEW DR.
SAN DIEGO CA
92119-2022
US

IV. Provider business mailing address

6848 BONNIE VIEW DR.
SAN DIEGO CA
92119-2022
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-6720
  • Fax: 760-945-6535
Mailing address:
  • Phone: 619-940-6720
  • Fax: 760-945-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP30618
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: