MEDICARE: KATHLEEN YNEZ PROCTOR M.S., 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	SLP5225	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SLP5225	OTHER	AZ	LISCENSE NUMBER

General Provider Information

NPI Number	:	1730365362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN YNEZ PROCTOR M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	6400 UPTOWN BLVD NE #360 WEST
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110
Country	:	US
Telephone Number	:	505-855-9804
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 UPTOWN BLVD NE #360 WEST
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110
Country	:	US
Telephone Number	:	505-855-9804
Fax Number	:

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

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	12/22/2008

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Directions to “ KATHLEEN YNEZ PROCTOR M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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