Provider Demographics
NPI:1154759686
Name:FORTUNE, KATHLYN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHLYN
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:KATHLYNF
Other - Middle Name:
Other - Last Name:STROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5815 DOVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7242
Mailing Address - Country:US
Mailing Address - Phone:818-439-7217
Mailing Address - Fax:
Practice Address - Street 1:6076 BRISTOL PKWY
Practice Address - Street 2:STE 105
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6600
Practice Address - Country:US
Practice Address - Phone:310-642-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist