MEDICARE: KATRYNA L JOHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	122385	TX

General Provider Information

NPI Number	:	1477395465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRYNA L JOHN

Provider Business Mailing Address
First Line	:	14111 VANCE JACKSON RD APT 4202
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1983
Country	:	US
Telephone Number	:	830-255-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	14111 VANCE JACKSON RD APT 4202
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1983
Country	:	US
Telephone Number	:	830-255-3255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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Directions to “ KATRYNA L JOHN ” Practice Location

Language	Start Address	Practice Location

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