Provider Demographics
NPI:1992866545
Name:KATHRYN J WAGE
Entity type:Organization
Organization Name:KATHRYN J WAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:559-228-9100
Mailing Address - Street 1:2505 W SHAW AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3334
Mailing Address - Country:US
Mailing Address - Phone:559-228-9100
Mailing Address - Fax:559-228-9100
Practice Address - Street 1:2505 W SHAW AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3334
Practice Address - Country:US
Practice Address - Phone:559-228-9100
Practice Address - Fax:559-228-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty