Provider Demographics
NPI:1194281469
Name:VELASCO, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 W 182ND ST APT 41
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5038
Mailing Address - Country:US
Mailing Address - Phone:347-981-3812
Mailing Address - Fax:
Practice Address - Street 1:16 SUMNER PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4110
Practice Address - Country:US
Practice Address - Phone:718-336-9500
Practice Address - Fax:718-336-9505
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist