Provider Demographics
NPI:1215492897
Name:ABBENE, KATHRYN M (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:ABBENE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22391 ROSEBRIAR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4615
Mailing Address - Country:US
Mailing Address - Phone:949-633-6078
Mailing Address - Fax:
Practice Address - Street 1:23652 ANTONIO PKWY
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-4949
Practice Address - Country:US
Practice Address - Phone:949-888-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist