Provider Demographics
NPI:1487066064
Name:WAGE, KATHRYN JANE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JANE
Last Name:WAGE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2505 W SHAW AVE STE 101
Mailing Address - Street 2:
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:559-228-9200
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:559-228-9200
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist