Basic Information
Provider Information
NPI: 1003292426
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KATSUYAMA
FirstName: YVONNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: , M.S., CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2530 DOUGLAS BLVD
Address2: SUITE 130
City: ROSEVILLE
State: CA
PostalCode: 956613989
CountryCode: US
TelephoneNumber: 9167973307
FaxNumber:  
Practice Location
Address1: 2530 DOUGLAS BLVD
Address2: SUITE 130
City: ROSEVILLE
State: CA
PostalCode: 956613989
CountryCode: US
TelephoneNumber: 9167973307
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/07/2015
LastUpdateDate: 12/14/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSP 20763CAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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