Provider Demographics
NPI:1487069118
Name:SELLERS, KATELYN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 PATRICK HENRY DR BLDG 23 STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1819
Mailing Address - Country:US
Mailing Address - Phone:408-807-6807
Mailing Address - Fax:
Practice Address - Street 1:4701 PATRICK HENRY DRIVE BLDG 23 STE D
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054
Practice Address - Country:US
Practice Address - Phone:408-807-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14035572OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
CA19962OtherCALIFORNIA SPEECH, LANGUAGE, AND HEARING AID DISPENSER'S BOARD