Provider Demographics
NPI:1518682871
Name:GARCIA, KATIE N
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:N
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 SYMPHONY CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3149
Mailing Address - Country:US
Mailing Address - Phone:760-696-6260
Mailing Address - Fax:
Practice Address - Street 1:3416 AMERICAN RIVER DR STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5753
Practice Address - Country:US
Practice Address - Phone:916-979-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75962355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7596OtherSPEECH LANGUAGE PATHOLOGY & AUDIOLOGY & HEARING AID DISPENSERS BOARD