Provider Demographics
NPI:1083851547
Name:WINSLOW, KATHY L (RDH, COM)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:RDH, COM
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:WINSLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH, COM
Mailing Address - Street 1:PO BOX 1232
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-1232
Mailing Address - Country:US
Mailing Address - Phone:650-712-1516
Mailing Address - Fax:650-712-1516
Practice Address - Street 1:931 VENTURA STREET
Practice Address - Street 2:
Practice Address - City:EL GRANADA
Practice Address - State:CA
Practice Address - Zip Code:94018
Practice Address - Country:US
Practice Address - Phone:650-712-1516
Practice Address - Fax:650-712-1516
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225500000X, 172M00000X
CA8820124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental Hygienist
No174400000XOther Service ProvidersSpecialist