Provider Demographics
NPI:1528687670
Name:FERNANDEZ, KATHARINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 COCKRELL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3001
Mailing Address - Country:US
Mailing Address - Phone:469-955-2830
Mailing Address - Fax:
Practice Address - Street 1:1000 W CROSBY RD STE 136
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6904
Practice Address - Country:US
Practice Address - Phone:972-237-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist