Provider Demographics
NPI:1285947796
Name:KOHL, CECILIA MARY (MS)
Entity type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:MARY
Last Name:KOHL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2630 ROYAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-2247
Mailing Address - Country:US
Mailing Address - Phone:925-285-1397
Mailing Address - Fax:925-743-1971
Practice Address - Street 1:2630 ROYAL OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507
Practice Address - Country:US
Practice Address - Phone:925-285-1397
Practice Address - Fax:925-743-1971
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 4712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist