Basic Information
| Provider Information | |||||||||
| NPI: | 1255667051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATANASOVA | ||||||||
| FirstName: | KATERINA | ||||||||
| MiddleName: | NIKOLAEVA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5741 CROWNTREE LN APT 203 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328298048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072222522 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 320 DUNDAS DR STE 8 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322185591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047571782 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2009 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 9402 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.