Provider Demographics
NPI:1497310809
Name:VERNIKOV, YEKATERINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:
Last Name:VERNIKOV
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 1:967 KAINUI DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2027
Mailing Address - Country:US
Mailing Address - Phone:812-219-2952
Mailing Address - Fax:
Practice Address - Street 1:967 KAINUI DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2027
Practice Address - Country:US
Practice Address - Phone:812-219-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist