Basic Information
| Provider Information | |||||||||
| NPI: | 1326472465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAK | ||||||||
| FirstName: | KATHY | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5152 HEIL AVE APT 41 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926493650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627737521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5762 BOLSA AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926491172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142922322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP16439 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.