MEDICARE: KATHRYN P WONG MS, CCC-SLP

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	10127	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2344108	OTHER	CA	UNITED HEALTHCARE
2	107984	OTHER	CA	HEALTH NET
3	SP0101270	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1598724205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN P WONG MS, CCC-SLP

Provider Business Mailing Address
First Line	:	912 RICH AVE
Second Line	:	APT. #3
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2472
Country	:	US
Telephone Number	:	650-245-7170
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 EL CAMINO REAL
Second Line	:	SUITE 218
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1099
Country	:	US
Telephone Number	:	650-245-7170
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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