Provider Demographics
NPI:1386803278
Name:MENDOZA, MARY KATHLYN OCHOA (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MARY KATHLYN
Middle Name:OCHOA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1055 OAKWOOD AVE
Mailing Address - Street 2:APARTMENT 9
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5561
Mailing Address - Country:US
Mailing Address - Phone:510-367-7955
Mailing Address - Fax:
Practice Address - Street 1:1055 OAKWOOD AVE
Practice Address - Street 2:APARTMENT 9
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5561
Practice Address - Country:US
Practice Address - Phone:510-367-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist