MEDICARE: KATHRYN J WAGE

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	2647	CA

General Provider Information

NPI Number	:	1992866545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHRYN J WAGE

Provider Business Mailing Address
First Line	:	2505 W SHAW AVE
Second Line	:	BUILDING A
City	:	FRESNO
State	:	CA
Zip	:	93711-3334
Country	:	US
Telephone Number	:	559-228-9100
Fax Number	:	559-228-9100

Provider Business Practice Location Address
First Line	:	2505 W SHAW AVE
Second Line	:	BUILDING A
City	:	FRESNO
State	:	CA
Zip	:	93711-3334
Country	:	US
Telephone Number	:	559-228-9100
Fax Number	:	559-228-9100

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. KATHRYN J WAGE
Credential	:	M.A., CCC-SLP
Telephone Number	:	559-228-9100

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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