Provider Demographics
NPI:1881760379
Name:VENNE, KATHLEEN MARY (SLPA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:VENNE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 CAMPBELL
Mailing Address - Street 2:#101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207
Mailing Address - Country:US
Mailing Address - Phone:818-242-0340
Mailing Address - Fax:
Practice Address - Street 1:438 W LAS TUNAS DRIVE
Practice Address - Street 2:SAN GABRIEL VALLEY MEDICAL CENTER
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-570-6587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLPA2242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant