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NPI Code Detail

MEDICARE: KATHERINE PIETSCH CCC-SLP

MEDICARE:   KATHERINE  PIETSCH  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
1235Z00000XSpeech-Language Pathologist21845CA

General Provider Information

NPI Number : 1942612841
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE PIETSCH CCC-SLP
Provider Business Mailing Address
First Line : 5033 KILKEE ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-1406
Country : US
Telephone Number : 360-920-3812
Fax Number :
Provider Business Practice Location Address
First Line : 5033 KILKEE ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-1406
Country : US
Telephone Number : 360-920-3812
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2014
Last Update Date : 05/27/2014

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Directions to “ KATHERINE PIETSCH CCC-SLP” Practice Location

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