Provider Demographics
NPI:1992305544
Name:SCHICKENBERG, KATRINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:SCHICKENBERG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:GRUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:715 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1911
Mailing Address - Country:US
Mailing Address - Phone:408-507-1873
Mailing Address - Fax:
Practice Address - Street 1:715 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1911
Practice Address - Country:US
Practice Address - Phone:408-507-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist