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General NPI Number Information
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NPI Number | 1821608670
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Entity Type | Organization
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Legal Business Name | NORTH STAR SPEECH AND LANGUAGE PATHOLOGY CENTER, INC.
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 3555 KENYON ST STE 102
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City | SAN DIEGO
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State | CA
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Zip | 92110-5341
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Country | US
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Telephone | 619-436-1187
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Fax | 858-221-4058
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Provider Business Mailing Address
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Address Line | 4624 W POINT LOMA BLVD UNIT 3
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City | SAN DIEGO
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State | CA
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Zip | 92107-1441
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Country | US
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Telephone | 619-436-1187
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHERINE MCKERNAN-MCCRACKEN
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Credential | SLPD, CCC-SLP
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Telephone | 619-436-1187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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