MEDICARE: KATHLEEN WU

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

General Provider Information

NPI Number	:	1780164988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN WU

Provider Business Mailing Address
First Line	:	3605 BROWN ST APT 108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 BROWN ST APT 10108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4723
Country	:	US
Telephone Number	:	214-796-4883
Fax Number	:

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

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	08/16/2018

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Directions to “ KATHLEEN WU ” Practice Location

Language	Start Address	Practice Location

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