Basic Information
Provider Information
NPI: 1326449810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NECKEL
FirstName: KATELYN
MiddleName: IRENE
NamePrefix:  
NameSuffix:  
Credential: SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 725 WELCH RD
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943041601
CountryCode: US
TelephoneNumber: 6504978000
FaxNumber:  
Practice Location
Address1: 725 WELCH RD
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943041601
CountryCode: US
TelephoneNumber: 6504978000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/15/2014
LastUpdateDate: 02/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X9186CAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


Home