Provider Demographics
NPI:1235602921
Name:ISAACSON, KATHERINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11175
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87192-0175
Mailing Address - Country:US
Mailing Address - Phone:505-804-5358
Mailing Address - Fax:505-501-7483
Practice Address - Street 1:2901 JUAN TABO BLVD NE STE 100A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1886
Practice Address - Country:US
Practice Address - Phone:505-804-5358
Practice Address - Fax:505-501-7483
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-2077235Z00000X
CA33686235Z00000X
COSLP.0005065235Z00000X
NMSLP7338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59920319Medicaid