Provider Demographics
NPI:1598279663
Name:SPEECH PEDALS
Entity type:Organization
Organization Name:SPEECH PEDALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNHUBER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:541-903-5430
Mailing Address - Street 1:65 UPPER CIR UNIT B
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9737
Mailing Address - Country:US
Mailing Address - Phone:917-846-9534
Mailing Address - Fax:
Practice Address - Street 1:20852 SE SUNNIBERG LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3759
Practice Address - Country:US
Practice Address - Phone:541-903-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty