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General NPI Number Information
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NPI Number | 1740518125
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Entity Type | Individual
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Provider Name | KATHRYN JOHNSON KETCHUM
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 180 GRAND AVE STE 300
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City | OAKLAND
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State | CA
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Zip | 94612
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Country | US
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Telephone | 650-339-9951
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2922
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City | EL GRANADA
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State | CA
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Zip | 94018-2922
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 16984
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License Number State | CA
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